Abstract
Purpose
Real-world studies to describe the use of first, second and third line therapies for the management and symptomatic treatment of dementia are lacking. This retrospective cohort study describes the first-, second- and third-line therapies used for the management and symptomatic treatment of dementia, and in particular Alzheimer’s Disease.
Methods
Medical records of patients with newly diagnosed dementia between 1997 and 2017 were collected using four databases from the UK, Denmark, Italy and the Netherlands.
Results
We identified 191,933 newly diagnosed dementia patients in the four databases between 1997 and 2017 with 39,836 (IPCI (NL): 3281, HSD (IT): 1601, AUH (DK): 4474, THIN (UK): 30,480) fulfilling the inclusion criteria, and of these, 21,131 had received a specific diagnosis of Alzheimer’s disease. The most common first line therapy initiated within a year (± 365 days) of diagnosis were Acetylcholinesterase inhibitors, namely rivastigmine in IPCI, donepezil in HSD and the THIN and the N-methyl-d-aspartate blocker memantine in AUH.
Conclusion
We provide a real-world insight into the heterogeneous management and treatment pathways of newly diagnosed dementia patients and a subset of Alzheimer’s Disease patients from across Europe.
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Acknowledgements
The European Medical Information Framework (EMIF) is a collaboration between industry and academic partners that aims to develop common technical and governance solutions to facilitate access to diverse electronic medical and research data sources. These analyses were supported by the Innovative Medicines Initiative (IMI: https://www.imi.europa.eu) Joint Undertaking under EMIF grant agreement no 115372, resources of which are composed of financial contributions from the European Union's Seventh Framework Programme (FP7/2007–2013) and EFPIA companies’ in kind contribution. RS is part-funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. We would like to thank all the patients enrolled/recorded in these EHR databases, without whom this research would not have been possible. The authors would like to acknowledge Alba Jené for her administrative support during submission to ethical review boards.
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GJ and MA were contractors for GSK at the time of this work. Over the timeframe of this project, MFG was previously employed by Boehringer Ingelheim Pharmaceuticals, Inc, Ridgefield, CT, USA and is currently employed by Teva Pharmaceuticals, Inc., Frazer, PA, USA. RS has received research funding within the last five years from Janssen, Roche and GSK.
Protection of human subjects
This study complies with regulatory requirements regarding patient privacy protection and ethical considerations in the countries in which this study was applied. Data anonymisation procedures were conducted to ensure data were fully anonymised; there was no patient identifiable information.
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James, G., Collin, E., Lawrance, M. et al. Treatment pathway analysis of newly diagnosed dementia patients in four electronic health record databases in Europe. Soc Psychiatry Psychiatr Epidemiol 56, 409–416 (2021). https://doi.org/10.1007/s00127-020-01872-2
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DOI: https://doi.org/10.1007/s00127-020-01872-2