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Galantamine treatment in Alzheimer's disease: response and long-term outcome in a routine clinical setting.

Wallin, Åsa LU ; Wattmo, Carina LU and Minthon, Lennart LU (2011) In Neuropsychiatric Disease and Treatment 7. p.565-576
Abstract
BACKGROUND:

In the absence of long-term, placebo-controlled studies of cholinesterase inhibitors in Alzheimer's disease (AD), analysis of the results of open-label trials becomes crucial. This study aimed to explore the three-year effects of galantamine treatment, as well as subgroups of response and adherence to treatment.



METHODS:

Two hundred and eighty patients with a clinical diagnosis of AD were included in the prospective, open-label, multicenter Swedish Alzheimer Treatment Study, and received galantamine treatment. Efficacy measures included cognitive tests, ie, the Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS-cog), functional rating... (More)
BACKGROUND:

In the absence of long-term, placebo-controlled studies of cholinesterase inhibitors in Alzheimer's disease (AD), analysis of the results of open-label trials becomes crucial. This study aimed to explore the three-year effects of galantamine treatment, as well as subgroups of response and adherence to treatment.



METHODS:

Two hundred and eighty patients with a clinical diagnosis of AD were included in the prospective, open-label, multicenter Swedish Alzheimer Treatment Study, and received galantamine treatment. Efficacy measures included cognitive tests, ie, the Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS-cog), functional rating (Instrumental Activities of Daily Living Scale [IADL]), and global rating. Assessments were carried out before treatment and every six months for a period of three years. K-means cluster analysis was used to identify response subgroups.



RESULTS:

After three years of treatment, the mean change from baseline was 2.6 points in MMSE and 5.6 points in ADAS-cog scores. Globally, half of the patients improved or remained unchanged for two years. Cluster analysis identified two response clusters. Cluster 1 included patients with low ability in ADAS-cog and IADL scores at baseline. Even though the patients in cluster 1 were older and less educated, they responded better at six months compared with patients in cluster 2. Cluster 2 included patients with better ADAS-cog and IADL scores at baseline. Patients in cluster 2 had a higher frequency of the APOE ɛ4 allele, a slower pretreatment progression rate, and remained in the study longer than those in cluster 1. Three-year completers (n = 129, 46%) received higher doses of galantamine compared with dropouts.



CONCLUSION:

AD patients who received long-term galantamine treatment were cognitively and globally stabilized. Subgroup response analysis identified a better short-term response in older patients with lower cognitive and functional abilities at baseline, a faster pretreatment progression rate, and a lower incidence of the APOE ɛ4 allele. The galantamine dose was higher in the population of completers. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Alzheimer’s disease, long-term treatment, routine setting, cholinesterase inhibitor, galantamine, k-means cluster analysis, completion rates
in
Neuropsychiatric Disease and Treatment
volume
7
pages
565 - 576
publisher
Dove Press
external identifiers
  • wos:000297995600001
  • pmid:22003296
ISSN
1176-6328
DOI
10.2147/NDT.S24196
language
English
LU publication?
yes
id
f44392bb-94dd-4bd1-ab22-f3c35700f9df (old id 2200449)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/22003296?dopt=Abstract
date added to LUP
2011-11-02 10:29:59
date last changed
2016-09-20 05:39:03
@article{f44392bb-94dd-4bd1-ab22-f3c35700f9df,
  abstract     = {BACKGROUND:<br/><br>
In the absence of long-term, placebo-controlled studies of cholinesterase inhibitors in Alzheimer's disease (AD), analysis of the results of open-label trials becomes crucial. This study aimed to explore the three-year effects of galantamine treatment, as well as subgroups of response and adherence to treatment.<br/><br>
<br/><br>
METHODS:<br/><br>
Two hundred and eighty patients with a clinical diagnosis of AD were included in the prospective, open-label, multicenter Swedish Alzheimer Treatment Study, and received galantamine treatment. Efficacy measures included cognitive tests, ie, the Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS-cog), functional rating (Instrumental Activities of Daily Living Scale [IADL]), and global rating. Assessments were carried out before treatment and every six months for a period of three years. K-means cluster analysis was used to identify response subgroups.<br/><br>
<br/><br>
RESULTS:<br/><br>
After three years of treatment, the mean change from baseline was 2.6 points in MMSE and 5.6 points in ADAS-cog scores. Globally, half of the patients improved or remained unchanged for two years. Cluster analysis identified two response clusters. Cluster 1 included patients with low ability in ADAS-cog and IADL scores at baseline. Even though the patients in cluster 1 were older and less educated, they responded better at six months compared with patients in cluster 2. Cluster 2 included patients with better ADAS-cog and IADL scores at baseline. Patients in cluster 2 had a higher frequency of the APOE ɛ4 allele, a slower pretreatment progression rate, and remained in the study longer than those in cluster 1. Three-year completers (n = 129, 46%) received higher doses of galantamine compared with dropouts.<br/><br>
<br/><br>
CONCLUSION:<br/><br>
AD patients who received long-term galantamine treatment were cognitively and globally stabilized. Subgroup response analysis identified a better short-term response in older patients with lower cognitive and functional abilities at baseline, a faster pretreatment progression rate, and a lower incidence of the APOE ɛ4 allele. The galantamine dose was higher in the population of completers.},
  author       = {Wallin, Åsa and Wattmo, Carina and Minthon, Lennart},
  issn         = {1176-6328},
  keyword      = {Alzheimer’s disease,long-term treatment,routine setting,cholinesterase inhibitor,galantamine,k-means cluster analysis,completion rates},
  language     = {eng},
  pages        = {565--576},
  publisher    = {Dove Press},
  series       = {Neuropsychiatric Disease and Treatment},
  title        = {Galantamine treatment in Alzheimer's disease: response and long-term outcome in a routine clinical setting.},
  url          = {http://dx.doi.org/10.2147/NDT.S24196},
  volume       = {7},
  year         = {2011},
}