Aging
Treatment patterns of symptomatic therapies for Alzheimer’s Disease and Related Dementias Huiwen Deng* Huiwen Deng Todd A. Lee Charles E. Gaber Kibum Kim Stephanie Y. Crawford Elizabeth A. Bayliss Xiaojuan Li
Currently approved symptomatic therapies for patients with Alzheimer’s Disease and Related Dementias (ADRD) target cognitive and behavioral symptoms and may temporarily improve quality of life, yet their real-world treatment patterns remain underexplored. We identified senior ADRD patients (≥65 years) who newly initiated an acetylcholinesterase inhibitor (AChEIs: donepezil, rivastigmine, galantamine), memantine, or their combination from 2011 to 2019. Treatment patterns were assessed by summarizing initial therapy, treatment changes (switching or discontinuation), and retreatment following the first discontinuation during the 3 years following initiation. We assessed factors associated with switching or discontinuation of the initial therapy using subdistribution hazard model in which we controlled for patient demographics, clinical characteristics, and healthcare encounters. The analytic cohort included 68,434 AChEI, 14,038 memantine, and 4,711 dual therapy initiators. The median age was 82 years (IQR: 77, 87), and 62% were female. Donepezil accounted for the largest subset of the treatment initiators across the years (63% in 2011 to 73% in 2019). AChEI initiators had fewer comorbidities, similar frailty levels, and lower neuropsychiatric drug use at baseline compared to other initiators. Following initiation, 46% switched or discontinued their initial therapy within 6 months, with only 3% remaining on their initial therapy after 3 years. Dual therapy initiators had the highest switching (44%) and lowest discontinuation rates (30%), while donepezil initiators had the lowest switching (19%) but highest discontinuation rates (54%). Among those who discontinued treatment, 39% reinitiated treatment, with a median duration of 90 days to reinitiation (IQR: 62, 157). Elevated risk of switching was linked to younger age, while geographic location appeared to influence both switching and discontinuation. The results showed poor persistence to symptomatic therapy for ADRD.
