Cholinesterase inhibitor use in Alzheimer's disease : the EPIFARM-Elderly Project

Purpose: This study was designed to examine the prevalence of cholinesterase inhibitor (ChEI) use and the proportions of patients treated with ChEIs by using an administrative prescription database of prevalent and incident cases of mild to moderate Alzheimer's disease (AD) in relation to age and duration of therapy. Methods: A prospective observational study covering individuals aged 65years or older who received at least one prescription of ChEIs between 1 January 2002 and 31 December 2007 was conducted in three health administrative areas in the Lombardy Region, Italy. Results: The prevalence of those who received at least one prescription for ChEIs rose from 0.5% in 2002 to 0.7% in 2004, reaching a plateau. Among estimated prevalent cases of mild to moderate AD, the prevalence of patients who received at least one prescription of ChEIs varied in different age groups, rising in those over 80years and falling slightly in those under 80years, particularly in patients aged 65-69years (test for trend, p<0.001). Among estimated incident cases, the percentage of newly treated patients dropped from 12% in 2004 to 8% in 2007, as well as within each age group (test for trend, p<0.001). In the cohort of incident users, nearly 40% of patients who started treatment in 2004 were still in treatment 3years later. Conclusions: The prescription prevalence of ChEIs increased up to 2004, then reached a plateau. This might reflect the practical response of physicians and patients to the controversy and uncertainty surrounding the clinical value of these expensive drugs for the treatment of AD.