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Comparative analysis of mortality in patients with Alzheimer's disease treated with donepezil or galantamine
Secundino López-Pousa1, Josep Garre Olmo, Joan Vilalta Franch
1Research Unit, Institut d'Assistència Sanitaria, C/Dr. Castany s/n, Salt 17190 (Girona), Spain. recerca@ias.scs.es
Insights
Long-term use of galantamine and donepezil does not increase mortality in Alzheimer's disease patients. Factors like male gender, older age, and heart failure are associated with mortality risk.
Area of Science:
- Neurology
- Pharmacology
- Geriatrics
Background:
- Limited research exists on the long-term impact of cholinesterase inhibitors (ChEIs) on mortality.
- Alzheimer's disease (AD) management often involves ChEIs like galantamine and donepezil.
Purpose of the Study:
- To compare the long-term effects of galantamine versus donepezil on mortality rates in Alzheimer's disease patients.
- Investigate mortality associations in AD patients undergoing ChEI treatment.
Main Methods:
- Retrospective cohort study involving 404 probable AD patients.
- Standardized medical record review for treatment duration, dosage, and outcomes.
- Multivariate logistic regression analysis to identify mortality predictors.
Main Results:
- No significant difference in mortality rates between galantamine and donepezil treated groups.
- 14.5% initial intolerance and 18.5% discontinuation rates for ChEIs.
- Mortality associated with male gender, advanced age, heart failure, antipsychotic use, and dementia severity.
Conclusions:
- Treatment duration and dosage of galantamine or donepezil are not linked to increased mortality.
- Advanced age, male gender, heart failure, dementia severity, and antipsychotic use are key mortality-associated factors in AD.
Background:
few studies have analysed the effect of the long-term use of cholinesterase inhibitors (ChEIs) on mortality.
Objective:
to compare the long-term effects of galantamine and donepezil treatment on the mortality rate in Alzheimer's disease (AD) patients.
Design:
a retrospective cohort study.
Setting And Subjects:
404 patients referred by primary care centres to a Memory Clinic who were diagnosed with probable AD and who were prescribed treatment with donepezil or galantamine.
Methods:
standardised review of the patient's medical records.
Results:
14.5% of the patients showed intolerance to the treatment with ChEIs during the first 15 days. Of those patients who initially tolerated the treatment, 18.5% gave it up after a mean duration of 13.36 months and a mean dose of 7.5 mg/day of donepezil or 14.3 mg/day of galantamine. The mean duration of the treatment in patients who did not abandon the treatment was 25.4 months and the mean dose was 8.1 mg/day of donepezil or 20.0 mg/day of galantamine. There were no differences in the mortality rate between patients treated with donepezil or galantamine (13.7 versus 12.2; P = 0.75). The multivariate analysis through binary logistic regression showed that the variables associated with mortality were male gender, older age, heart failure, treatment with antipsychotic drugs and a high score on the Global Deterioration Scale.
Conclusions:
the duration and the dose of donepezil or galantamine are not related to an increase in mortality. The related variables were advanced age, the severity of the dementia, being male, heart failure and treatment with antipsychotic drugs.
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