Comparison of cholinesterase inhibitor safety in real‐world practice
Abstract Introduction Cholinesterase inhibitors (ChEIs) are widely used to treat mild to moderate Alzheimer's disease and related dementia. Clinical trials have focused on placebo comparisons, inadequately addressing within‐class comparative safety. Methods New users of ChEIs in British Columbi...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Alzheimer’s & Dementia: Translational Research & Clinical Interventions |
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| Online Access: | https://doi.org/10.1016/j.trci.2019.09.011 |
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| _version_ | 1849688408360747008 |
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| author | Greg Carney Ken Bassett James M. Wright Malcolm Maclure Nicolette McGuire Colin R. Dormuth |
| author_facet | Greg Carney Ken Bassett James M. Wright Malcolm Maclure Nicolette McGuire Colin R. Dormuth |
| author_sort | Greg Carney |
| collection | DOAJ |
| description | Abstract Introduction Cholinesterase inhibitors (ChEIs) are widely used to treat mild to moderate Alzheimer's disease and related dementia. Clinical trials have focused on placebo comparisons, inadequately addressing within‐class comparative safety. Methods New users of ChEIs in British Columbia were categorized into five study cohorts: low‐dose donepezil, high‐dose donepezil, galantamine, rivastigmine patch, and oral rivastigmine. Comparative safety of ChEIs assessed hazard ratios using propensity score adjusted Cox regression. Results Compared with low‐dose donepezil, galantamine use was associated with a lower risk of mortality (adjusted hazard ratio: 0.84, 95% confidence interval: 0.60–1.18), cardiovascular serious adverse events (adjusted hazard ratio: 0.78, 95% confidence interval: 0.62–0.98), and entry into a residential care facility (adjusted hazard ratio: 0.72, 95% confidence interval: 0.59–0.89). Discussion Given the absence of randomized trial data showing clinically meaningful benefit of ChEI therapy in Alzheimer's disease, our study suggests preferential use of galantamine may at least be associated with fewer adverse events than treatment with donepezil or rivastigmine. |
| format | Article |
| id | doaj-art-ea71b9cc00a44930aec4afd955327d9e |
| institution | DOAJ |
| issn | 2352-8737 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Alzheimer’s & Dementia: Translational Research & Clinical Interventions |
| spelling | doaj-art-ea71b9cc00a44930aec4afd955327d9e2025-08-20T03:22:00ZengWileyAlzheimer’s & Dementia: Translational Research & Clinical Interventions2352-87372019-01-015173273910.1016/j.trci.2019.09.011Comparison of cholinesterase inhibitor safety in real‐world practiceGreg Carney0Ken Bassett1James M. Wright2Malcolm Maclure3Nicolette McGuire4Colin R. Dormuth5Therapeutics InitiativeUniversity of British ColumbiaVancouverBCCanadaTherapeutics InitiativeUniversity of British ColumbiaVancouverBCCanadaTherapeutics InitiativeUniversity of British ColumbiaVancouverBCCanadaTherapeutics InitiativeUniversity of British ColumbiaVancouverBCCanadaResearch and Innovation Division, B.C. Ministry of HealthVictoriaBCCanadaTherapeutics InitiativeUniversity of British ColumbiaVancouverBCCanadaAbstract Introduction Cholinesterase inhibitors (ChEIs) are widely used to treat mild to moderate Alzheimer's disease and related dementia. Clinical trials have focused on placebo comparisons, inadequately addressing within‐class comparative safety. Methods New users of ChEIs in British Columbia were categorized into five study cohorts: low‐dose donepezil, high‐dose donepezil, galantamine, rivastigmine patch, and oral rivastigmine. Comparative safety of ChEIs assessed hazard ratios using propensity score adjusted Cox regression. Results Compared with low‐dose donepezil, galantamine use was associated with a lower risk of mortality (adjusted hazard ratio: 0.84, 95% confidence interval: 0.60–1.18), cardiovascular serious adverse events (adjusted hazard ratio: 0.78, 95% confidence interval: 0.62–0.98), and entry into a residential care facility (adjusted hazard ratio: 0.72, 95% confidence interval: 0.59–0.89). Discussion Given the absence of randomized trial data showing clinically meaningful benefit of ChEI therapy in Alzheimer's disease, our study suggests preferential use of galantamine may at least be associated with fewer adverse events than treatment with donepezil or rivastigmine.https://doi.org/10.1016/j.trci.2019.09.011Cholinesterase inhibitorAlzheimer's diseaseDementiaLog‐binomial regressionCox proportional hazardPropensity score |
| spellingShingle | Greg Carney Ken Bassett James M. Wright Malcolm Maclure Nicolette McGuire Colin R. Dormuth Comparison of cholinesterase inhibitor safety in real‐world practice Alzheimer’s & Dementia: Translational Research & Clinical Interventions Cholinesterase inhibitor Alzheimer's disease Dementia Log‐binomial regression Cox proportional hazard Propensity score |
| title | Comparison of cholinesterase inhibitor safety in real‐world practice |
| title_full | Comparison of cholinesterase inhibitor safety in real‐world practice |
| title_fullStr | Comparison of cholinesterase inhibitor safety in real‐world practice |
| title_full_unstemmed | Comparison of cholinesterase inhibitor safety in real‐world practice |
| title_short | Comparison of cholinesterase inhibitor safety in real‐world practice |
| title_sort | comparison of cholinesterase inhibitor safety in real world practice |
| topic | Cholinesterase inhibitor Alzheimer's disease Dementia Log‐binomial regression Cox proportional hazard Propensity score |
| url | https://doi.org/10.1016/j.trci.2019.09.011 |
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