Start Date
5-27-2021 9:00 AM
End Date
5-27-2021 5:00 PM
Description
Background: Prior studies have focused on the clinical efficacy of combination therapy, Donepezil and Memantine, for patient’s diagnosed with Alzheimer’s disease. However, the potential adverse drug reactions while described as mild can have serious sequelae in older adults who are already managing the side effects of polypharmacy.
Objective: This study looks to explore the tolerability of switching cholinesterase inhibitors to memantine monotherapy versus adding memantine as combination therapy for all-cause neurodegenerative disorders.
Methods: The study is a retrospective chart review that includes 175 patients aged 50 and older diagnosed with neurocognitive disorders (ICD 10 F00-F03.91 and ICD10 G30-G31.84) managed on combination therapy, memantine monotherapy and CI monotherapy from 2016-2019.
Results: The odds of a patient reporting side effects on combination therapy in comparison with those patients on memantine monotherapy reporting side effects were significantly greater (OR = 4.33, CI 95% (1.62, 11.52), p=0.003). There was marginal significance in variables such as polypharmacy (p=0.057) and dosing of cholinesterase inhibitors (p = 0.087) in a binary logistic regression model (Table 1). Of the patient population who qualified as excessive polypharmacy (>10), more than half 60% reported side effects.
Discussion: The likelihood of reporting side effects is significantly increased for patients on combination therapy when compared to those on monotherapy(p=0.003). Sample size was a limiting factor in determining significant predictors for those reporting side effects on combination therapy; however, there was marginal significance for patients on > 4 other medications while on combination therapy (p=0.057) in predicting outcomes. In our patient sample, more than 80% of the patients reporting side effects qualified as polypharmacy or excessive polypharmacy.
Keywords
dementia, alzheimer's disease, medication safety, polypharmacy
Included in
Tolerability of Switching Cholinesterase Inhibitors to Memantine Monotherapy Versus Adding Memantine as Combination Therapy for All-Cause Neurodegenerative Disorders
Background: Prior studies have focused on the clinical efficacy of combination therapy, Donepezil and Memantine, for patient’s diagnosed with Alzheimer’s disease. However, the potential adverse drug reactions while described as mild can have serious sequelae in older adults who are already managing the side effects of polypharmacy.
Objective: This study looks to explore the tolerability of switching cholinesterase inhibitors to memantine monotherapy versus adding memantine as combination therapy for all-cause neurodegenerative disorders.
Methods: The study is a retrospective chart review that includes 175 patients aged 50 and older diagnosed with neurocognitive disorders (ICD 10 F00-F03.91 and ICD10 G30-G31.84) managed on combination therapy, memantine monotherapy and CI monotherapy from 2016-2019.
Results: The odds of a patient reporting side effects on combination therapy in comparison with those patients on memantine monotherapy reporting side effects were significantly greater (OR = 4.33, CI 95% (1.62, 11.52), p=0.003). There was marginal significance in variables such as polypharmacy (p=0.057) and dosing of cholinesterase inhibitors (p = 0.087) in a binary logistic regression model (Table 1). Of the patient population who qualified as excessive polypharmacy (>10), more than half 60% reported side effects.
Discussion: The likelihood of reporting side effects is significantly increased for patients on combination therapy when compared to those on monotherapy(p=0.003). Sample size was a limiting factor in determining significant predictors for those reporting side effects on combination therapy; however, there was marginal significance for patients on > 4 other medications while on combination therapy (p=0.057) in predicting outcomes. In our patient sample, more than 80% of the patients reporting side effects qualified as polypharmacy or excessive polypharmacy.
Comments
Presented at the 2021 House Staff Quality Improvement and Patient Safety Conference