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Efficacy of rivastigmine in subjects with moderately severe Alzheimer's disease.

AbstractBACKGROUND:
Cholinesterase (ChE) inhibitors are primarily used in the treatment of mild to moderate Alzheimer's disease (AD), but may also be effective in more severe disease.
OBJECTIVE:
To evaluate the dual ChE inhibitor, rivastigmine, in more severe dementia.
METHODS:
We retrospectively analysed pooled data from three randomised, placebo-controlled, double-blind, 6-month trials, involving 2126 AD subjects. Subjects were selected according to baseline Mini-Mental State Examination (MMSE) score to identify subjects with more severe cognitive impairment (10-12 MMSE points). One-hundred-and-seventeen subjects were included who had been treated with rivastigmine 6-12 mg/day or placebo. The AD Assessment Scale-Cognitive Subscale (ADAS-Cog), the MMSE, a six-item subscore of the Progressive Deterioration Scale (PDS) and the BEHAVE-AD assessed efficacy. Tolerability was assessed by recording adverse events (AEs) and the relative risk (RR) of discontinuation.
RESULTS:
This group of subjects responded well to rivastigmine. After 6 months, the mean ADAS-Cog score declined by 6.3 points in the placebo group and increased by 0.2 points in the rivastigmine group (observed cases; p<0.001). Clinical benefits were also observed with the MMSE, the six-item PDS score and items of the BEHAVE-AD. Rivastigmine showed the same pattern of AEs as in other studies, but the RR of dropping out due to AEs was lower than in subjects with milder AD.
CONCLUSION:
Current treatment guidelines do not recommend treating individuals with severe AD with ChE inhibitors. However, this retrospective analysis suggests that rivastigmine 6-12 mg/day may benefit subjects with more severe disease, as well as subjects with mild to moderate impairment.
AuthorsA Burns, R Spiegel, P Quarg
JournalInternational journal of geriatric psychiatry (Int J Geriatr Psychiatry) Vol. 19 Issue 3 Pg. 243-9 (Mar 2004) ISSN: 0885-6230 [Print] England
PMID15027039 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
CopyrightCopyright 2004 John Wiley & Sons, Ltd.
Chemical References
  • Carbamates
  • Cholinesterase Inhibitors
  • Phenylcarbamates
  • Rivastigmine
Topics
  • Aged
  • Aged, 80 and over
  • Alzheimer Disease (drug therapy)
  • Carbamates (administration & dosage, adverse effects)
  • Cholinesterase Inhibitors (administration & dosage, adverse effects)
  • Female
  • Humans
  • Male
  • Middle Aged
  • Models, Statistical
  • Multicenter Studies as Topic
  • Phenylcarbamates
  • Randomized Controlled Trials as Topic
  • Retrospective Studies
  • Rivastigmine
  • Treatment Outcome

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