If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  DG DISPATCH - ECNP: Longest Term Effects To Date Shown In Latest Donepezil Studies By Cameron Johnston Special to DG News LONDON, UK -- September 23, 1999 -- Although patients in some countries have been able to use donepezil (Aricept, Pfizer) for periods approaching six years in the treatment of Alzheimer’s disease, doctors still cannot say with any certainty which patients will benefit from it and which ones will not.
At the European College of Neuropsychopharmacology (ECNP) meeting, being held in London, UK, this week, researchers from Sweden and the US said that despite the long-term gains that are appearing in numerous clinical trials, they still cannot predict who will be the best candidates for treatment. "The response to donepezil has been variable, and we have no predictors that will tell us who will respond and who will not respond," said Dr. Murali Doraiswamy, director of clinical trials in psychiatry, and an assistant professor of medicine and geriatrics at Duke University Medical Center in Durham, North Carolina. The possible exception to this, he said, is concomitant use of estrogen "but I’m not convinced about that data." "I don’t see any typical neurological or psychiatric pattern in patients who will or will not respond," added Dr. Bengt Winblad, a professor in the department of geriatric medicine at Huddinge University Hospital, in Huddinge, Sweden. The patient’s family situation is important, however, and positive support from the patient’s caregiver means the patient will be more likely to stay on the medication longer, he added. Realistically, it’s important to let the caretaker know that any improvement "is a bonus… this is a treatment for symptoms, not a cure," Dr. Doraiswamy said. "Patients need realistic expectations about the drug and its effects. Sustained noticeable response is seen only in early treatment. We would not expect to see this over a period of time. With all other medications you’re expecting an improvement, not just stabilization. But with Alzheimer’s disease, stabilization is an outcome in itself, that’s what’s important. A slower decline is what you want to see." Meanwhile, the latest studies on donepezil show that it does, indeed have a longer term benefit - at least one year and, quite probably, more. The results of a study conducted by Professor Winblad in Sweden showed statistically significant differences on Mini Mental State Exam (MMSE) scores and the Progressive Deterioration Score (PDS) at 24, 36 and 52 weeks. Mean decline in MMSE scores for the patients in the placebo group was 2.5 points, while those in the donepezil group experienced a mean decline of less than one-half point. "This reflects what we can observe. They are more active and more able to take part in daily activities. Now we have confirmed it, this is the first study to show these benefits over a full year," Dr. Winblad said in an interview. "Even longer term effects might continue, and we have studies, not yet complete, now going out to three years," he added. A second clinical trial, also placebo-controlled, was conducted at the Bronx VA Medical Center, in New York, and at Baylor College of Medicine, in Houston, TX. Among patients who used donepezil for a year, there were significant differences in the ability to perform specific activities of daily living, including using a telephone, "household tasks", handling money and personal mail, and "grasping or being able to explain a situation". Dr. Doraiswamy also advised family doctors not to recommend donepezil to patients based on a single visit, or a single assessment, but to "average the clinical impressions out" over two or three visits, and to pay particular attention to what the caregiver is saying about the patient. "Stabilization is the goal. You have to allow several months to see if there is a benefit," he explained. "The patient will lose benefit if the drug is withdrawn, but we know that the benefit may last up to one year, and perhaps more."
|
