Rivastigmine patch for treatment of Alzheimer's disease in clinical practice in Thailand

• Published in: Psychogeriatrics Vol. 13; no. 1; pp. 1 - 8
• Main Authors: KULKANTRAKORN, Kongkiat, TANYAKITPISAL, Panas, TOWANABUT, Somchai, DEJTHEVAPORN, Charungthai, RANGSEEKAJEE, Poonsri, PONGPAKDEE, Sunsanee, LAPTIKULTHAM, Somsak, RODPRASERT, Kritsada, SETTHAWATCHARAWANICH, Suwanna, THINKHAMROP, Bandit
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.03.2013; Blackwell Publishing Ltd
• Subjects: Age; Aged; Alzheimer Disease - drug therapy; Alzheimer Disease - psychology; Alzheimer's disease; Cholinesterase Inhibitors - administration & dosage; Cholinesterase Inhibitors - adverse effects; Cognition - drug effects; cognitive functioning; Dose-Response Relationship, Drug; Drug therapy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Phenylcarbamates - administration & dosage; Phenylcarbamates - adverse effects; Prospective Studies; Rivastigmine; safety; Severity of Illness Index; Thailand; tolerability; Transdermal medication; Transdermal Patch; Treatment Outcome; Thailand
• ISSN: 1346-3500; 1479-8301
• DOI: 10.1111/j.1479-8301.2012.00403.x

Background:  Rivastigmine is a cholinesterase inhibitor for treatment of mild to moderate Alzheimer's disease (AD) and dementia associated with Parkinson's disease. The new patch formulation was recently made available. We assessed the safety, tolerability, and cognitive outcome of rivastigmine patch in treatment of mild to moderate AD in clinical practice in Thailand. Methods:  A multicentre, hospital‐based, prospective observational study was conducted in nine hospitals across Thailand. Patients with probable mild to moderate AD who received the rivastigmine patch were enrolled. Data were collected data at baseline, weeks 4–8 and after week16. Results:  A total of 116 AD patients were screened, and three were excluded. Of 113 patients, 62.8% were women with a mean age of 73.3 ± 9.2 years; 79.7% were newly diagnosed. One‐third of all patients had been using antipsychotic or antidepressant medication. Common comorbidities were hypertension and dyslipidemia. The Thai Mental State Examination score significantly increased from 18.6 to 20.3 (weeks 4–8) and 20.4 (week 16+) (P < 0.001). Scores based on physicians’ (Clinical Global Impression) and caregivers’ (Patients’ Caregiver Global Impression of Change) impressions of improvement suggested minimal improvement. Because of adverse events, seven patients's dosages were reduced 10 cm2 to 5 cm2 or from 5 cm2 to nothing. Itching was the most common adverse symptom. Conclusions:  During the first 16 weeks after initiation of rivastigmine patch therapy, patients with probable mild to moderate AD had statistically significant improvement in cognitive function, but clinically marginal benefit. Rivastigmine was safe and well tolerated.