Galantamine treatment in Alzheimer's disease: response and long-term outcome in a routine clinical setting
Åsa K Wallin, Carina Wattmo, Lennart MinthonClinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, SwedenBackground: In the absence of long-term, placebo-controlled studies of cholinesterase inhibitors in Alzheimer's disease (AD...
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Dove Medical Press
2011
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oai:doaj.org-article:d29fe1bc9eab474d9048816361a95a2a2021-12-02T02:50:35ZGalantamine treatment in Alzheimer's disease: response and long-term outcome in a routine clinical setting1176-63281178-2021https://doaj.org/article/d29fe1bc9eab474d9048816361a95a2a2011-09-01T00:00:00Zhttp://www.dovepress.com/galantamine-treatment-in-alzheimer39s-disease-response-and-long-term-o-a8388https://doaj.org/toc/1176-6328https://doaj.org/toc/1178-2021Åsa K Wallin, Carina Wattmo, Lennart MinthonClinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, SwedenBackground: 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 ε4 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 ε4 allele. The galantamine dose was higher in the population of completers.Keywords: Alzheimer's disease, long-term treatment, routine setting, cholinesterase inhibitor, galantamine, k-means cluster analysis, completion ratesWallin ÅKWattmo CMinthon LDove Medical PressarticleNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol 2011, Iss Issue 1, Pp 565-576 (2011) |
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Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 |
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Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Wallin ÅK Wattmo C Minthon L Galantamine treatment in Alzheimer's disease: response and long-term outcome in a routine clinical setting |
| description |
Åsa K Wallin, Carina Wattmo, Lennart MinthonClinical Memory Research Unit, Department of Clinical Sciences, Lund University, Malmö, SwedenBackground: 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 ε4 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 ε4 allele. The galantamine dose was higher in the population of completers.Keywords: Alzheimer's disease, long-term treatment, routine setting, cholinesterase inhibitor, galantamine, k-means cluster analysis, completion rates |
| format |
article |
| author |
Wallin ÅK Wattmo C Minthon L |
| author_facet |
Wallin ÅK Wattmo C Minthon L |
| author_sort |
Wallin ÅK |
| title |
Galantamine treatment in Alzheimer's disease: response and long-term outcome in a routine clinical setting |
| title_short |
Galantamine treatment in Alzheimer's disease: response and long-term outcome in a routine clinical setting |
| title_full |
Galantamine treatment in Alzheimer's disease: response and long-term outcome in a routine clinical setting |
| title_fullStr |
Galantamine treatment in Alzheimer's disease: response and long-term outcome in a routine clinical setting |
| title_full_unstemmed |
Galantamine treatment in Alzheimer's disease: response and long-term outcome in a routine clinical setting |
| title_sort |
galantamine treatment in alzheimer's disease: response and long-term outcome in a routine clinical setting |
| publisher |
Dove Medical Press |
| publishDate |
2011 |
| url |
https://doaj.org/article/d29fe1bc9eab474d9048816361a95a2a |
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