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Continuous treatment with antidementia drugs in Germany 2003–2013: a retrospective database analysis

Published online by Cambridge University Press:  22 April 2015

Jens Bohlken ,
Simon Weber ,
Michael A. Rapp  and
Karel Kostev
Jens Bohlken
Affiliation:
Praxis Bohlken, Berlin, Germany
Simon Weber
Affiliation:
Charité Berlin, Berlin-Brandenburg Center for Regenerative Therapies, Berlin, Germany
Michael A. Rapp*
Affiliation:
Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
Karel Kostev
Affiliation:
Epidemiology & Evidence Based Medicine, Real World Evidence Solutions, IMS Health, Frankfurt, Germany
*
Correspondence should be addressed to: Michael A. Rapp, MD, PhD, Professor for Social and Preventive Medicine, University of Potsdam, Am Neuen Palais 10, D-14469 Potsdam, Germany. Phone: +49 331 977 4095; Fax: +49 331 977 4078. Email: michael.rapp@uni-potsdam.de.
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Abstract

Background:

Continuous treatment is an important indicator of medication adherence in dementia. However, long-term studies in larger clinical settings are lacking, and little is known about moderating effects of patient and service characteristics.

Methods:

Data from 12,910 outpatients with dementia (mean age 79.2 years; SD = 7.6 years) treated between January 2003 and December 2013 in Germany were included. Continuous treatment was analysed using Kaplan–Meier curves and log-rank tests. In addition, multivariate Cox regression models were fitted with continuous treatment as dependent variable and the predictors antidementia agent, age, gender, medical comorbidities, physician specialty, and health insurance status.

Results:

After one year of follow-up, nearly 60% of patients continued drug treatment. Donezepil (HR: 0.88; 95% CI: 0.82–0.95) and memantine (HR: 0.85; 0.79–0.91) patients were less likely to be discontinued treatment as compared to rivastigmine users. Patients were less likely to be discontinued if they were treated by specialist physicians as compared to general practitioners (HR: 0.44; 0.41–0.48). Younger male patients and patients who had private health insurance had a lower discontinuation risk. Regarding comorbidity, patients were more likely to be continuously treated with the index substance if a diagnosis of heart failure or hypertension had been diagnosed at baseline.

Conclusions:

Our results imply that besides type of antidementia agent, involvement of a specialist in the complex process of prescribing antidementia drugs can provide meaningful benefits to patients, in terms of more disease-specific and continuous treatment.

Keywords

Alzheimer’s diseasedementiatreatment continuationpersistenceadherencecholinesterase inhibitorsmemantine
Type
Research Article
Information
International Psychogeriatrics , Volume 27 , Issue 8 , August 2015 , pp. 1335 - 1342
Copyright
Copyright © International Psychogeriatric Association 2015 

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