Gary S. Figiel Carl H. Sadowsky John Strigas Barbara Koumaras Xiangyi Meng Ibrahim Gunay
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Objective: Switching patients with
Alzheimer's disease from one cholinesterase inhibitor
to another represents a viable option for patients
not responding to current therapy. The objective
of this large U.S.-based study was to evaluate the safety and efficacy of a treatment switch to
rivastigmine in patients not responding adequately
to or declining on treatment with donepezil.
Method: In this 26-week, prospective,
open-label, single-arm, multicenter study
conducted from April 24, 2003, to June 25, 2004,
patients with mild-to-moderate Alzheimer's disease (DSM-IV-TR criteria) who were not
responding to donepezil were treated with rivastigmine
3-12 mg/day. Safety and tolerability were measured
by the occurrence of adverse events and patient
disposition. Treatment effects on global
functioning were assessed using the Clinical Global
Impression of Change (CGIC) scale.
Results: Two hundred seventy patients with
a mean age of 78.5 (SD = 7.56) years and a mean duration of dementia of 3.5 (SD = 2.06)
years were included in the study. Sixty-nine percent
of patients completed the study with 17.8% discontinuing due to adverse events. Eighty-three
percent of patients reported at least 1 adverse
event, with the most frequently occurring adverse
events affecting the gastrointestinal system (54%).
The majority of patients were reported to have
either improvement or no decline on the CGIC. A
limitation of the study is that the interpretation of
the results is based on an overall completion rate
of 69%.
Conclusions: Immediately switching
patients from donepezil to rivastigmine without a
washout period was safe and well tolerated in the
current study. Additionally, these results suggest that
patients not responding adequately to or declining while taking donepezil may improve or
stabilize after switching to rivastigmine.
Prim Care Companion J Clin Psychiatry 2008;10(4):291-298
https://doi.org/10.4088/PCC.v10n0404
© Copyright 2008 Physicians Postgraduate Press, Inc.