Patterns of Symptomatic Therapies Utilized in Alzheimer's Disease and Related Dementias

Monday, August 26, 2024

2:45 PM – 3:00 PM CEST

Location: Room II

Presenting Author(s)

Huiwen Deng, PharmD, MPH (she/her/hers)

PhD Candidate
Department of Pharmacy, Systems, Outcomes, and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA
Chicago, United States

Slides Handouts

Co-Author(s)

TL

Todd A. Lee, PharmD, PhD

Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, United States
Charles E. Gaber, PhD, MPH (he/him/his)

Assistant Professor
Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, Chicago, IL, USA, United States
KK

Kibum Kim, BPharm, PhD

Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, United States
SC

Stephanie Y. Crawford, PhD, MPH

Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, Chicago, IL, USA, United States
EB

Elizabeth A. Bayliss, MD, MSPH

Senior Scientific Investigator
Institute for Health Research, Kaiser Permanente Colorado, Central Support Services, 16601 East Centretech Parkway, Aurora, CO, USA; Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
Aurora, United States
SS

Sonal Singh, MD, MPH, FACP

Associate Professor
Department of Family Medicine and Community Health, UMass Chan Medical School, Worcester MA, USA
UMass Chan Medical School
Worcester, United States
JY

Jessica Gerald Young, PhD

Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA, United States
DT

Darren Toh, ScD

Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA, United States
Xiaojuan Li, PhD, MSPH (she/her/hers)

Assistant Professor
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
Boston, United States

Background: Approved symptomatic treatments for Alzheimer's Disease and Related Dementias (ADRD) target cognitive and behavioral symptoms, potentially offering temporary quality of life enhancements. Yet, there is limited evidence on their real-world utilization.

Objectives: To provide an update on symptomatic therapy use patterns among patients diagnosed with ADRD.

Methods: Using Merative MarketScan and Medicare Supplemental data (2010-2022), we selected ADRD patients aged 65 and older who newly initiated treatment with an acetylcholinesterase inhibitor (AChEIs: donepezil, rivastigmine, galantamine), memantine, or dual therapy (an AChEI and memantine) between 2011 and 2019. We summarized initial therapy and first treatment change (switching to AChEI, memantine, or dual therapy; discontinuation) in the 3 post-initiation years. We identified factors (patient demographics, clinical characteristics, or healthcare encounters) associated with first treatment change using subdistribution hazard models. Among monotherapy initiators, we assessed progression to advanced therapies (memantine or dual therapy). For those who discontinued their symptomatic therapy, we examined time from their first discontinuation to reinitiation with any symptomatic therapy.

Results: Among the 68,434 AChEI, 14,038 memantine, and 4,711 dual therapy initiators identified, the median age was 82 years (IQR: 77-87), with females comprising 62%. Donepezil initiators represented the majority, increasing from 63% in 2011 to 73% in 2019. AChEI initiators had less comorbidity, comparable frailty, and lower baseline neuropsychiatric medication use than their counterparts. Following initiation, 46% changed from their initial therapy within 6 months, and only 3% remained on their initial therapy within 3 years. At year 3, 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%). Increased switching risk was associated with younger age, and geographic location appeared to impact all treatment changes. Among monotherapy initiators, 12% started memantine within 3 years, with a median duration of 230 days (IQR: 96-482) to initiation, while 24% progressed to the adoption of dual therapy, with a median duration of 243 days to initiation (IQR: 103-484). Among those who discontinued their therapy, 39% reinitiated treatment within 3 years, with a median duration of 45 days to reinitiation (IQR: 17-114).

Conclusions: Patients with ADRD exhibited low persistence with their initial symptomatic treatment, evidenced by prevalent switching and discontinuation. Notably, there were high rates of reinitiation following discontinuation.