Benefit in longer term use of Aricept?

In a study published today in the New England Journal of Medicine, researchers in the UK studied nearly 300 people with moderate or severe Alzheimer’s who had been treated with donepezil for at least three months. In this group of people with moderate to severe Alzheimer’s, those people who were on medication did better than those who were off medication.

Background

Donepezil, also known as Aricept, is a cholinesterase inhibitor is approved to treat all stages of Alzheimer’s. Memantine, also known as Namenda, is approved by the FDA for treatment of moderate to severe Alzheimer’s.There is some evidence that individuals with moderate to severe Alzheimer’s who are taking Aricept might benefit by also taking memantine.

The claim

The researchers observed individuals with Alzheimer’s in the study experienced statistically significant cognitive and functional benefits of continuing donepezil over 12 months. These benefits were “clinically important,” that is, they were noticeable to an outside observer and could have a beneficial impact on day to day life. Furthermore, initiation of memantine therapy was also associated with better cognition and function, although the benefits were below the threshold of “clinical importance.” Finally, the researchers concluded that adding memantine to donepezil treatment failed to show significant benefits.

The methodology

The researchers worked with 295 patients with moderate or severe Alzheimer’s disease who had been treated with donepezil for at least 3 months. Four treatment strategies were tested: (1) continue donepezil, (2) discontinue donepezil, (3) discontinue donepezil and start memantine, or (4) continue donepezil and start memantine. Patients received the study treatment for one year.

Beyond the headline

Previous studies showed that donepezil combined with memantine was better than either alone. Because of this, many of the patients with whom we work are prescribed both medications. This new study calls this practice into question.

The study also showed that patients benefitted from donepezil in later stages of the disease. While this finding isn’t new, in clinical practice many physicians question the impact of this medication in the late stages. It is common for donepezil to be stopped at this point as it is perceived to be of no use. This new study suggests that perhaps donepezil may continue to help even in these later stages and should be continued for a longer period than is now the norm.

The bottom line

We desperately need better treatments for Alzheimer’s; treatments with much larger benefits for those who take them; treatments that slow or stop the progression of the disease. While the FDA approved medications have “statistically significant” effects in some persons with dementia, in many the benefits are subtle. Patients and families are eager for better treatments now.

For more information on the latest news and developments in Alzheimer’s research, visit www.alz.org/research.