Real-world evaluation of compliance and preference in Alzheimer’s disease treatment

Ming-Chyi Pai,1,2 Hany Aref,3 Nazem Bassil,4 Nagaendran Kandiah,5 Jae-Hong Lee,6 AV Srinivasan,7 Shelley diTommaso,8 Ozgur Yuksel81Division of Behavioral Neurology, Department of Neurology, 2Alzheimer’s Disease Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City, Taiwan; 3Department of Neurology, Ain Shams University, Cairo, Egypt; 4Saint Georges Hospital Medical Center, Balamand University, Beirut, Lebanon; 5Department of Neurology, National Neuroscience Institute, Tan Tock Seng Hospital, Singapore; 6Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, South Korea; 7The Tamil Nadu Dr MGR Medical University, Chennai, Tamil Nadu, India; 8Novartis Pharma AG, Postfach, Basel, SwitzerlandPurpose: Rivastigmine transdermal patch has shown higher caregiver satisfaction and greater preference than oral formulation in patients with Alzheimer’s disease. However, there is limited literature available related to caregiver preference or treatment compliance in real-world clinical settings. To date, no such data are available from Asia and the Middle East, which account for a sizeable proportion of patients with Alzheimer’s disease. The objective of this study was to evaluate treatment preference and compliance with oral and transdermal medications in daily clinical practice in an ethnically diverse patient population from Asia and the Middle East with mild-to-moderate Alzheimer’s disease.Patients and methods: RECAP (Real-world Evaluation of Compliance And Preference in the treatment of Alzheimer’s disease) was a 24-week, multicenter, prospective, noninterventional study. Two treatment cohorts were observed during the study: oral (cholinesterase inhibitors or memantine) and transdermal (rivastigmine patch). Caregiver preference, physician preference, and patient compliance were evaluated at week 24.Results: A total of 978 of 1,931 enrolled patients (mean age: 72.8 years; 50.5% female) were in the transdermal cohort. For patients with exposure to both oral and transdermal monotherapy (n=330), a significant caregivers’ preference for the transdermal monotherapy was observed (82.7%; P<0.0001). Of the 89 participating physicians, 71 indicated preference for transdermal monotherapy. Patient compliance was also significantly higher for transdermal than oral monotherapy (P<0.0001).Conclusion: Our study showed higher caregiver and physician preference and greater patient compliance with transdermal monotherapy in daily practice.Keywords: rivastigmine, Alzheimer’s disease, cholinesterase inhibitors, patient compliance, observational study, transdermal patc