A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
Use of antidementia drugs and risk of pneumonia in older persons with Alzheimer's disease
Tekijät: Lampela Pasi, Tolppanen Anna-Maija, Tanskanen Antti, Tiihonen Jari, Lavikainen Piia, Hartikainen Sirpa, Taipale Heidi
Kustantaja: TAYLOR & FRANCIS LTD
Julkaisuvuosi: 2017
Journal: Annals of Medicine
Tietokannassa oleva lehden nimi: ANNALS OF MEDICINE
Lehden akronyymi: ANN MED
Vuosikerta: 49
Numero: 3
Aloitussivu: 230
Lopetussivu: 239
Sivujen määrä: 10
ISSN: 0785-3890
eISSN: 1365-2060
DOI: https://doi.org/10.1080/07853890.2016.1254349
Tiivistelmä
Introduction: Persons with Alzheimer's disease are at an increased risk of pneumonia, but the comparative risks during specific antidementia treatments are not known. We compared the risk of pneumonia in the use of donepezil, rivastigmine (oral, transdermal), galantamine and memantine.Patients and methods: We used data from a nationwide cohort of community-dwelling individuals diagnosed with Alzheimer's disease during 2005-2011 in Finland, who initiated monotherapy with acetylcholinesterase inhibitor or memantine (n = 65,481). The risk of hospitalization or death due to pneumonia was investigated with Cox proportional hazard models.Results: The risk of pneumonia was higher in persons using rivastigmine patch (n = 9709) (adjusted hazard ratio (HR) 1.15, 95% confidence interval (CI) 1.04-1.27) and memantine (n = 11,024) (HR 1.59, 95% CI 1.48-1.71) compared with donepezil users (n = 26,416) whereas oral rivastigmine (n = 7384) (HR 1.08, 95% CI 0.98-1.19) and galantamine (n = 10,948) (HR 0.91, 95% CI 0.83-1.00) were not associated with an increased risk. These results did not change when adjusting for comorbid conditions, use of psychotropic drugs or with inverse probability of treatment weighting.Discussion: The increased risk of pneumonia in this fragile group of aged persons should be taken into account. Memantine is associated with the highest risk in the comparison of antidementia drugs.KEY MESSAGEPneumonia risk is increased in persons with Alzheimer's disease who use memantine or rivastigmine patches.
Introduction: Persons with Alzheimer's disease are at an increased risk of pneumonia, but the comparative risks during specific antidementia treatments are not known. We compared the risk of pneumonia in the use of donepezil, rivastigmine (oral, transdermal), galantamine and memantine.Patients and methods: We used data from a nationwide cohort of community-dwelling individuals diagnosed with Alzheimer's disease during 2005-2011 in Finland, who initiated monotherapy with acetylcholinesterase inhibitor or memantine (n = 65,481). The risk of hospitalization or death due to pneumonia was investigated with Cox proportional hazard models.Results: The risk of pneumonia was higher in persons using rivastigmine patch (n = 9709) (adjusted hazard ratio (HR) 1.15, 95% confidence interval (CI) 1.04-1.27) and memantine (n = 11,024) (HR 1.59, 95% CI 1.48-1.71) compared with donepezil users (n = 26,416) whereas oral rivastigmine (n = 7384) (HR 1.08, 95% CI 0.98-1.19) and galantamine (n = 10,948) (HR 0.91, 95% CI 0.83-1.00) were not associated with an increased risk. These results did not change when adjusting for comorbid conditions, use of psychotropic drugs or with inverse probability of treatment weighting.Discussion: The increased risk of pneumonia in this fragile group of aged persons should be taken into account. Memantine is associated with the highest risk in the comparison of antidementia drugs.KEY MESSAGEPneumonia risk is increased in persons with Alzheimer's disease who use memantine or rivastigmine patches.
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