Transdermal Is Better than Oral: Observational Research of the Satisfaction of Caregivers of Patients with Alzheimer’s Disease Treated with Rivastigmine

Abstract

Background and Aims: Poor adherence to anti-dementia drugs is common among patients with Alzheimer’s disease. This study evaluated whether caregivers were more satisfied with, and patients more adherent to, transdermal rivastigmine than oral rivastigmine. Methods: Neurologists, psychiatrists and geriatricians collected sociodemographic and clinical data from 1,078 patients and administered the Treatment Satisfaction with Medicines (SATMED-Q) and the Morisky-Green questionnaires to their caregivers at outpatient consultations. Results: Satisfaction reported was greater with transdermal than oral rivastigmine: mean ± SD of the total SATMED-Q score, 72.5 ± 14.1 vs. 65.2 ± 12.5, p < 0.001. The proportion of adherent patients was greater with transdermal than with oral rivastigmine (65.0 vs. 41.4%, p < 0.001). Satisfaction, in turn, was significantly greater in adherent cases than in nonadherent cases. Conclusions: Facilitating the administration of anti-dementia drugs would improve adherence.

Factors Associated with Greater Adherence to and Satisfaction with Transdermal Rivastigmine in Patients with Alzheimer's Disease and Their Caregivers

“…This finding therefore suggests that transdermal application may increase treatment satisfaction among caregivers and help to overcome common practical barriers to adherence [4]. In contrast to the results of Boada and Arranz [8], however, our study found no evidence of an association between satisfaction with and adherence to patch treatment. This inconsistency in the findings may be attributed to the larger sample size used in the former study and the differential use of adherence and satisfaction measurements [i.e.…”

“…Furthermore, the proportion of caregivers reporting ‘often' or ‘always' engaging in a non-adherent behaviour was less than 10% at both time points. These findings mirror the results of an earlier study of patients using transdermal rivastigmine, which identified similar levels of adherence (65%) [8]. However, as adherence was assessed by self-report, it is possible that the true level of adherence may have been lower than observed here.…”

“…Caregiver perceptions about the treatment administration and their satisfaction with the treatment may therefore be of equal importance in understanding non-adherence to AD treatments. A recent study by Boada and Arranz [8] found evidence of a relationship between caregiver satisfaction and adherence to rivastigmine. Their study reported that caregiver satisfaction was positively correlated with adherence, the use of transdermal application and patients' scores on the Mini-Mental State Examination (MMSE).…”

The Use of Cholinesterase Inhibitors Across All Stages of Alzheimer’s Disease

“…A 9.5 mg/24 h (10 cm 2 ) patch was approved in 2007 by the FDA for mild-to-moderate AD, and a 13.3 mg/24 h (15 cm 2 ) patch was approved in 2013 for severe AD. The advantages of the patch compared with oral administration include increased adherence, improved tolerability, continuous drug delivery, and reduced fluctuations in drug concentration [27,28]. Use of the patch compared with the capsule may also allow a greater percentage of patients to reach and maintain the maximum doses of rivastigmine [29].…”

A 24-Week, Open-Label Extension Study to Investigate the Long-term Safety, Tolerability, and Efficacy of 13.3 mg/24 h Rivastigmine Patch in Patients With Severe Alzheimer Disease

“…[22][23][24] In practical terms, transdermal delivery has a number of advantages over oral capsules for patients with AD and their caregivers; the patch acts as a visual reminder that medication has been taken; 25 patch administration is easier, particularly in patients who are confused or display behavioral problems; 25 patch delivery is well-suited for patients who have difficulty swallowing. Although caregiver preference for transdermal versus oral formulations has not been confirmed in a sub-population of patients with severe AD, it is anticipated that the simple treatment regimen offered by a transdermal patch would also appeal to caregivers of patients with more advanced disease.…”