Examining Anti-Dementia Drug Persistence in Alzheimer's Disease (AD) Patients (P07.140)

OBJECTIVE: To describe patient persistence with anti-dementia medications in an AD center and to evaluate characteristics associated with persistence. BACKGROUND: Cholinesterase inhibitors and Memantine are the only FDA approved medications for treating Alzheimer9s disease. Persistent treatment may slow the rate of decline (Rountree et al 2009, Atri et al 2008, Lopez et al 2009), while discontinuation is linked to cognitive and behavioral worsening (Doody et al 2001). Data regarding persistence of anti-dementia drug use in outpatients is scarce. DESIGN/METHODS: Of 1106 consecutive patients with probable AD followed longitudinally, 1073 had complete information regarding cumulative anti-dementia drug use (start and stop dates) from the time of initial symptoms onward. We examined demographic and neuropsychological data for each of the following five groups of patients: those who never took anti-dementia medications (N=69); those who started before their new patient visit (NPV) and persisted (N=425); those who started before the NPV and discontinued medication(s) at least once (N=115); those who started after the NPV and persisted (N=369): and those who started after the NPV and discontinued at least once (N=95). RESULTS: Of the 1004 patients who were ever treated, 54% started treatment prior to the NPV and 46% started treatment after the NPV. There were 794 persistent users (79%) and 210 (21%) were impersistent. The groups were comparable with respect to age, sex, education, estimated pre-morbid IQ, pre-progression rate, physician9s estimate of duration, but baseline Mini-mental status examination scores were slightly higher in persistent users (1.13 +/- 6.51, p=0.03). CONCLUSIONS: Overall, persistence with anti-dementia drug treatment was high. There were no demonstrated demographic or disease characteristics that explained differences in persistence. This suggests that social factors and/or perceived side effects may have accounted for impersistence. Disclosure: Dr. Biernot has nothing to disclose. Dr. Darby has nothing to disclose. Dr. Chan has nothing to disclose. Dr. Pavlik has nothing to disclose. Dr. Doody has received personal compensation for activities with AC Immune, Biote, Cardeus, Genzyme Corporation, Hoffman-La Roche, Eli Lilly & Company, Medivation, Merck & Co., Inc., Nutricia, QR Pharma, Shire Pharmaceuticals, Sonexa, Suven, Takeda Pharmaceutical, Transition, and Zinfandel. Dr. Doody9s institution has received research support from Jannsen, Genentech, Inc., and Pfizer, Inc.