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| |  WCN: Donepezil Preferred To Rivastigmine For Physician Convenience In Alzheimer's Treatment By Richard Robinson Special to DG News
LONDON, ENGLAND -- June 18, 2001 -- In the first direct comparison of the two major anticholinesterase inhibitors for Alzheimer’s disease, physicians were more satisfied with donepezil than with rivastigmine, according to a study presented today at the 17th World Congress of Neurology here. Both donepezil (Aricept) and rivastigmine (Exelon) are used widely to treat Alzheimer’s disease (AD), noted Peter Passmore of the Department of Geriatric Medicine, Queens College, Belfast, Ireland. Comparing efficacy and tolerability across trials is difficult, however, because of variations in design, baseline characteristics, and other factors. Because of this, Dr. Passmore and colleagues undertook a 12-week, multi-center, open-label comparison of the two drugs, designed to mimic clinical practice as closely as possible. One hundred eleven treatment-naive patients with mild to moderate AD were enrolled and randomly assigned to either donepezil or rivastigmine. Titration and dosing schedules followed the product labeling, with donepezil patients receiving 5 mg and then 10 mg once daily, and rivastigmine patients starting at 1.5 mg twice daily, and then being titrated upwards to a maximum of 6 mg twice daily. Dose reductions were made as needed to improve tolerability. At weeks 4 and 12, physicians and caregivers each completed a questionnaire regarding satisfaction and ease of use. For physicians, the questionnaire included six questions covering dosing frequency, titration, ease of use, and need for unscheduled treatment-related patient/caregiver contact. In the caregivers’ questionnaire, eight questions covered ease of use, satisfaction with dosing schedule, and need for physician contact regarding dosing or adverse events. Results showed that at both time points, physicians rated donepezil higher than rivastigmine in terms of satisfaction and ease of use, with significant differences for all items except need for patient/caregiver contact (p<0.0001). Caregivers also were more satisfied with donepezil, but the difference between ratings for the two drugs fell over time. By week 12, only ease of following directions and satisfaction with dosing frequency remained significantly different between the two. Adverse events for both drugs were similar to those seen in clinical trials, with nausea and vomiting more common for rivastigmine than for donepezil. Rivastigmine patients required more dose reductions from the target therapeutic dose. More rivastigmine patients withdrew (21 percent versus 11 percent, p=0.009), with treatment-related adverse events being the most common reason cited in both groups. Neither treatment group showed a significant mean improvement on the cognition subscale of the Alzheimer Disease Assessment Scale. "In this trial, designed to emulate the treatment of Alzheimer’s patients in a clinical situation, donepezil was better tolerated," Dr. Passmore concluded. He noted that not only were more donepezil patients able to complete the trial, but more treated patients were maintained at the maximum dose.
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