J Clin Neurol.  2021 Jul;17(3):376-384. 10.3988/jcn.2021.17.3.376.

Discontinuation Rate of Newly Prescribed Donepezil in Alzheimer’s Disease Patients in Asia

Affiliations
  • 1Department of Neurology, College of Medicine, Gachon University Gil Hospital, Incheon, Korea
  • 2Department of Neurology, Soonchunhyang University of College of Medicine, Cheonan Hospital, Cheonan, Korea
  • 3Memory Aging and Cognition Centre, Departments of Pharmacology and Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  • 4Department of Neurology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 5Institute for Neurosciences. St. Luke’s Medical Center, Taguig, Philippines
  • 6Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
  • 7Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea
  • 8Department of Neurology, College of Medicine, Hanyang University, Seoul, Korea
  • 9Department of Neurology, Chonbuk National University School of Medicine, Jeonju, Korea
  • 10Department of Neurology, Ewha Womans University Seoul Hospital, Seoul, Korea
  • 11Institute of Neurology, Huashan Hospital, Fudan University, Shanghai, China
  • 12Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
  • 13Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
  • 14Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Korea
  • 15Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
  • 16Department of Neurology, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
  • 17Nanjing Drum Tower Hospital, Nanjing, China
  • 18Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
  • 19Department of Neurology, the First Affiliated Hospital of Xi’an Jiaotong University, Shaanxi, China
  • 20Dementia Center, Department of Neurology, Taipei Medical University Shuang-Ho Hospital and School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
  • 21Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan
  • 22Department of Neurology, Peking University Third Hospital, Beijing, China
  • 23Department of Neurology, National Neuroscience Institute; Singapore, Duke-NUS Graduate Medical School, Singapore: Lee Kong Chian Medical School-NTU, Singapore
  • 24Department of Neurology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  • 25Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
  • 26Queen Mary Hospital, Department of Medicine, The University of Hong Kong, Hong Kong
  • 27Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Beijing, China
  • 28Department of Neurology, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
  • 29Department of Neurology, Inha University School of Medicine, Incheon, Korea
  • 30Department of Neurology, Seoul National University College of Medicine & Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, Korea

Abstract

Background and Purpose
The rate of donepezil discontinuation and the underlying reasons for discontinuation in Asian patients with Alzheimer’s disease (AD) are currently unknown. We aimed to determine the treatment discontinuation rates in AD patients who had newly been prescribed donepezil in routine clinical practice in Asia.
Methods
This 1-year observational study involved 38 institutions in seven Asian countries, and it evaluated 398 participants aged 50–90 years with a diagnosis of probable AD and on newly prescribed donepezil monotherapy. The primary endpoint was the rate of donepezil discontinuation over 1 year. Secondary endpoints included the reason for discontinuation,treatment duration, changes in cognitive function over the 1-year study period, and compliance as assessed using a clinician rating scale (CRS) and visual analog scale (VAS).
Results
Donepezil was discontinued in 83 (20.9%) patients, most commonly due to an adverse event (43.4%). The mean treatment duration was 103.67 days in patients who discontinued. Among patients whose cognitive function was assessed at baseline and 1 year, there were no significant changes in scores on the Mini-Mental State Examination, Montreal Cognitive Assessment, and Trail-Making Test–Black and White scores, whereas the Clinical Dementia Rating score increased significantly (p<0.001). Treatment compliance at 1 year was 96.8% (306/316) on the CRS and 92.6±14.1% (mean±standard deviation) on the VAS.
Conclusions
In patients on newly prescribed donepezil, the primary reason for discontinuation was an adverse event. Cognitive assessments revealed no significant worsening at 1 year, indicating that continuous donepezil treatment contributes to the maintenance of cognitive function.

Keyword

Alzheimer’s disease; Asia; cognition; donepezil
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