(68) Use of Symptomatic Treatments for Alzheimer's Disease Dementia

Publication Number: 1113

Background: Alzheimer's disease (AD) is the most common cause of dementia with physical, psychological, social, and economic impacts, not only for those affected by AD, but also their caregivers and families. Currently, there is no cure for AD; treatments primarily address AD symptoms and temporarily slow symptom worsening and improve quality of life. Based on the published literature, a large percentage (40-60%) of AD patients do not use symptomatic treatments for AD dementia. Published studies of current treatment patterns are limited.

Objectives: To describe treatment patterns including percent of AD patients using approved symptomatic AD dementia therapies, time to start of first treatment, and duration of use of therapy, in newly diagnosed AD patients in the US and UK.

Methods: Patients newly diagnosed with AD (ICD-10 code G30.xx or READ code for AD) in 2018-2019 (identification period), with ≥ 1-year baseline period before index date (first AD diagnosis date during identification period) and ≥ 1-year follow-up after the index date were selected from the Humana Research Database (Humana) and the Clinical Practice Research Datalink GOLD (CPRD). Patients could not have an AD diagnosis in the baseline period (12 months before the index date). Demographic characteristics and percentages of patients initiating donepezil, rivastigmine, galantamine, and memantine as mono- and combination therapy were calculated. Median time from diagnosis to first therapy start as well as time on therapy was calculated.

Results: Sixty-three percent of newly diagnosed AD patients were female with mean age 82 and 81 years, in the US (n=35,459) and UK (n=8,901), respectively. Over a median follow-up of 698 and 645 days, 63% and 65% of AD patients utilized symptomatic treatments for AD dementia, with 34% and 77% of those using treatments, newly initiating therapy (no use of therapy in the baseline period), in the US and UK, respectively. Among treatment initiators, median time to first therapy was 14 and 49 days with donepezil used most frequently (69% vs 61%), followed by memantine monotherapy (19% vs 28%) in the US and UK, respectively. Median time on first therapy was 213 and 334 days with 30% and 12% of patients utilizing a second symptomatic treatment for AD dementia, in the US and UK, respectively.

Conclusions: In contemporary cohorts of US and UK based individuals with newly diagnosed AD, approximately two thirds utilized approved symptomatic treatment for AD dementia. Time on first therapy was relatively short ( < 1 year) and the majority of patients did not move to a second therapy. These results underscore the unmet need for additional therapies to alleviate the significant burden of AD.