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Continuous treatment with antidementia drugs in Germany 2003–2013

  • Background: Continuous treatment is an important indicator of medication adherence in dementia. However, long-term studies in larger clinical settings are lacking, and little is known about moderating effects of patient and service characteristics. Methods: Data from 12,910 outpatients with dementia (mean age 79.2 years; SD = 7.6 years) treated between January 2003 and December 2013 in Germany were included. Continuous treatment was analysed using Kaplan-Meier curves and log-rank tests. In addition, multivariate Cox regression models were fitted with continuous treatment as dependent variable and the predictors antidementia agent, age, gender, medical comorbidities, physician specialty, and health insurance status. Results: After one year of follow-up, nearly 60% of patients continued drug treatment. Donezepil (HR: 0.88; 95% CI: 0.82-0.95) and memantine (HR: 0.85; 0.79-0.91) patients were less likely to be discontinued treatment as compared to rivastigmine users. Patients were less likely to be discontinued if they were treatedBackground: Continuous treatment is an important indicator of medication adherence in dementia. However, long-term studies in larger clinical settings are lacking, and little is known about moderating effects of patient and service characteristics. Methods: Data from 12,910 outpatients with dementia (mean age 79.2 years; SD = 7.6 years) treated between January 2003 and December 2013 in Germany were included. Continuous treatment was analysed using Kaplan-Meier curves and log-rank tests. In addition, multivariate Cox regression models were fitted with continuous treatment as dependent variable and the predictors antidementia agent, age, gender, medical comorbidities, physician specialty, and health insurance status. Results: After one year of follow-up, nearly 60% of patients continued drug treatment. Donezepil (HR: 0.88; 95% CI: 0.82-0.95) and memantine (HR: 0.85; 0.79-0.91) patients were less likely to be discontinued treatment as compared to rivastigmine users. Patients were less likely to be discontinued if they were treated by specialist physicians as compared to general practitioners (HR: 0.44; 0.41-0.48). Younger male patients and patients who had private health insurance had a lower discontinuation risk. Regarding comorbidity, patients were more likely to be continuously treated with the index substance if a diagnosis of heart failure or hypertension had been diagnosed at baseline. Conclusions: Our results imply that besides type of antidementia agent, involvement of a specialist in the complex process of prescribing antidementia drugs can provide meaningful benefits to patients, in terms of more disease-specific and continuous treatment.show moreshow less

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Metadaten
Author:Jens Bohlken, Simon Weber, Michael Armin RappORCiDGND, Karel Kostev
URN:urn:nbn:de:kobv:517-opus4-414718
DOI:https://doi.org/10.25932/publishup-41471
ISSN:1866-8364
Parent Title (English):Postprints der Universität Potsdam : Humanwissenschaftliche Reihe
Subtitle (English):a retrospective database analysis
Series (Serial Number):Postprints der Universität Potsdam : Humanwissenschaftliche Reihe (522)
Document Type:Postprint
Language:English
Date of first Publication:2019/02/11
Year of Completion:2015
Publishing Institution:Universität Potsdam
Release Date:2019/02/11
Tag:Alzheimer’s disease; adherence; cholinesterase inhibitors; dementia; memantine; persistence; treatment continuation
Issue:522
Pagenumber:8
Source:International Psychogeriatrics 27 (2015) 8, pp. 1335–1342 DOI 10.1017/S1041610215000654
Organizational units:Humanwissenschaftliche Fakultät
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Peer Review:Referiert
Publication Way:Open Access
Grantor:Cambridge University Press (CUP)
Licence (German):License LogoKeine Nutzungslizenz vergeben - es gilt das deutsche Urheberrecht
Notes extern:Bibliographieeintrag der Originalveröffentlichung/Quelle