Predictive Factors of Discontinuation and Switch of Cholinesterase Inhibitors in Community-Dwelling Patients with Alzheimerʼs Disease

Abstract

This study highlights four types of predictors of switch or discontinuation, reflecting disease progression, reconsideration of ChEI benefits, adverse drug reactions to ChEIs and inappropriate concurrent use of anticholinergic drugs. Attention should be paid to anticholinergic agents and prescribers should be given better information about these drugs.

Persistence and Adherence with Dementia Pharmacotherapy: Relevance of Patient, Provider, and System Factors

“…Additionally, hospitalization provides an opportunity to re-evaluate the relative risks and benefits of continued pharmacotherapy during a period of health instability. 47 The increased likelihood of ChEI discontinuation among AD patients following admission to hospice care in the study by Mansour et al 42 probably reflects a more appropriate focus on quality of life and reduced treatment burden in this patient population.…”

“…89 Selection of which agent to be used will be based on adverse effect profile, ease of use, familiarity, and differences between the agents in their pharmacokinetics and other mechanisms of action. 5 There was an increased risk for early discontinuation 36,43 (and switching) 36,47 with subtherapeutic dosages of the ChEIs, as well as evidence of increased persistence in patients with AD using memantine (with 38 or without 35 a ChEI). The latter finding may be explained by greater caregiver involvement in drug administration coupled with a decision to aggressively pursue therapy.…”

Comedication and Treatment Length in Users of Acetylcholinesterase Inhibitors

“…This variability has to some extent been explained by the prescriber, which could reflect prescription of drugs which are contraindicated in combination with AChEIs, or by individual patient variability [4]. Moreover, discontinuation of AChEIs or switch to another AChEI can be related to environment (hospitalizations/change of care), medications (adverse drug reactions to AChEIs and inappropriate concurrent use of anticholinergic agents), and patient factors (cognitive decline, anxiety, and weight loss) [5, 6, 7, 8]. Rapid cognitive decline has been shown to be linked to switching [8], indicating that the decision to switch to another AChEI may be made for a potentially better therapeutic response.…”

“…A drug holiday may be undertaken to assess the real benefit of AChEI use. AD-related hospitalization has been shown to be the strongest predictor of discontinuation [8]. …”

Tailored Information and Automated Reminding to Improve Medication Adherence in Spanish- and English-Speaking Elders Treated for Memory Impairment

“…Memory problems are commonly treated with cholinesterase inhibitors and for these patients adherence to a prescribed regimen of therapy is essential to maintaining cognitive function. In spite of the importance of sustained adherence to therapy, research suggest that these patients do not take their medications regularly or persistently (Borah, Sacco, & Zarotsky, 2010; Gadzhanova, Roughead, & Mackson, 2010; Gardette et al, 2010). Although no readily identifiable study has investigated interventions to promote adherence in this population, one group has reported on an intervention to improve medication adherence in patients treated for Parkinson’s disease (Grosset & Grosset, 2007).…”