TY - JOUR
T1 - Real-world effects of anti-dementia treatment on mortality in patients with Alzheimer´s dementia
AU - Nielsen, René Ernst
AU - Grøntved, Simon
AU - Lolk, Annette
AU - Andersen, Kjeld
AU - Valentin, Jan B.
N1 - Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.
PY - 2022/11/11
Y1 - 2022/11/11
N2 - To examine the real-world effects of the cholinesterase inhibitors (AChEI) on all-cause mortality. A nationwide, retrospective cohort study. Participants were diagnosed with incident AD in Denmark from January 1, 2000 to December 31, 2011 with follow-up until December 31, 2012. A total of 36,513 participants were included in the current study with 22,063 deaths during 132,426 person-years of follow-up. At baseline, patients not treated with AChEI (n = 28,755 [9961 males (35%)]) had a mean age ± standard deviation (SD) of 80.33 ± 7.98 years (78.97 ± 8.26 for males and 81.04 ± 7.98 for females), as compared to 79.95 ± 7.67 (78.87 ± 7.61 for males and 80.61 ± 7.63 for females) in the group exposed at baseline. Patients treated with AChEI had a beneficial hazard ratio (HR) of 0.69, 95% confidence interval (CI) (0.67-0.71) for all-cause mortality as compared to patients not treated, with donepezil (HR 0.80, 95% CI [0.77-0.82]) and galantamine (HR 0.93,95% CI [0.89-0.97]) having beneficial effects on mortality rate as compared to non-treatment, whereas rivastigmine (HR 0.99, 95% CI [0.95-1.03]) was associated with a mortality rate comparable to non-treatment with AChEI. Patients were primarily exposed to donepezil (65.8%) with rivastigmine (19.8%) and galantamine (14.4%) being used less often. These findings underscore the effect of AChEI on not only reducing speed of cognitive decline but also directly prolonging life, which could result in changes in treatment recommendation for when to stop treatment.
AB - To examine the real-world effects of the cholinesterase inhibitors (AChEI) on all-cause mortality. A nationwide, retrospective cohort study. Participants were diagnosed with incident AD in Denmark from January 1, 2000 to December 31, 2011 with follow-up until December 31, 2012. A total of 36,513 participants were included in the current study with 22,063 deaths during 132,426 person-years of follow-up. At baseline, patients not treated with AChEI (n = 28,755 [9961 males (35%)]) had a mean age ± standard deviation (SD) of 80.33 ± 7.98 years (78.97 ± 8.26 for males and 81.04 ± 7.98 for females), as compared to 79.95 ± 7.67 (78.87 ± 7.61 for males and 80.61 ± 7.63 for females) in the group exposed at baseline. Patients treated with AChEI had a beneficial hazard ratio (HR) of 0.69, 95% confidence interval (CI) (0.67-0.71) for all-cause mortality as compared to patients not treated, with donepezil (HR 0.80, 95% CI [0.77-0.82]) and galantamine (HR 0.93,95% CI [0.89-0.97]) having beneficial effects on mortality rate as compared to non-treatment, whereas rivastigmine (HR 0.99, 95% CI [0.95-1.03]) was associated with a mortality rate comparable to non-treatment with AChEI. Patients were primarily exposed to donepezil (65.8%) with rivastigmine (19.8%) and galantamine (14.4%) being used less often. These findings underscore the effect of AChEI on not only reducing speed of cognitive decline but also directly prolonging life, which could result in changes in treatment recommendation for when to stop treatment.
KW - Alzheimer Disease/drug therapy
KW - Donepezil/therapeutic use
KW - Female
KW - Galantamine/therapeutic use
KW - Humans
KW - Indans/therapeutic use
KW - Male
KW - Phenylcarbamates/therapeutic use
KW - Piperidines/adverse effects
KW - Retrospective Studies
KW - Rivastigmine/therapeutic use
KW - antidementia drugs
KW - pharmacoepidemiology
KW - mortality
KW - dementia
KW - nationwide
UR - http://www.scopus.com/inward/record.url?scp=85142145957&partnerID=8YFLogxK
U2 - 10.1097/MD.0000000000031625
DO - 10.1097/MD.0000000000031625
M3 - Journal article
C2 - 36397447
VL - 101
SP - E31625
JO - Medicine
JF - Medicine
SN - 0025-7974
IS - 45
M1 - e31625
ER -