Psychiatry - November 2008 - (Page 27)

[ORIGINAL RESEARCH] Relative Tolerability of Alzheimer’s Disease Treatments by GUSTAVO ALVA, MD, AND JEFFREY L. CUMMINGS, MD Dr. Alva is from ATP Clinical Research, Costa Mesa, California, and Dr. Cummings is from the University of California, Los Angeles, Alzheimer’s Disease Research Center, Los Angeles, California Psychiatry (Edgemont) 2008;5(11):27–36 ABSTRACT Objective: In the US, approved therapies for mild to moderate Alzheimer’s disease (AD) currently comprise three cholinesterase inhibitors (ChEIs: donepezil, galantamine, and rivastigmine), while the N-methyl-D-aspartate (NMDA) receptor antagonist memantine and the ChEI donepezil are approved for moderate to severe AD. The purpose of this study is to review the safety and tolerability of the ChEIs and memantine, based upon manufacturers’ data found in prescribing information (PI) documents. Design: Current PI documents for donepezil, galantamine, rivastigmine, and memantine were obtained from American manufacturers’ websites, accessed in September, 2007. Adverse events (AEs) data for each drug versus placebo were compiled and analyzed using odds ratios. Results: A review of PI data indicated that all three ChEIs are associated with cholinomimetic effects. Nausea (2–8%) and vomiting (1–5%) were reported across all ChEI trials as the most common reasons for trial discontinuation. Dizziness, anorexia, and diarrhea were also commonly experienced; however, a recent study suggests improved tolerability with transdermal administration of rivastigmine. The most frequently reported AEs in memantine trials were dizziness, headache, and FINANCIAL DISCLOSURES: Dr. Alva has received financial support from Forest Laboratories, Inc., Janssen, Novartis Pharmaceuticals, Astra-Zeneca, Corcept Therapeutics, Myriad Genetics, Inc., Bristol-Myers Squibb/Otsuka Pharmacuticals, Takeda Pharmaceuticals, Pfizer, and Organon; Dr. Cummings has received financial support from Forest Laboratories, Inc., Janssen, H. Lundbeck A/S, Merz Pharma, Myriad Genetics, Inc., Novartis Pharmaceuticals, Pfizer, Avanir Pharmaceuticals, Eisai, Neurochem Inc., Ono Pharmaceutical Co., SanofiAventis, Sepracor Inc., Takeda Pharmaceutical, and EnVivo Pharmaceuticals, Inc. ADDRESS CORRESPONDENCE TO: Gustavo Alva, MD, 3151 Airway Avenue, Costa Mesa, CA 92626; Phone: (714) 277-4472; Fax: (206) 326-4038; E-mail: galva@theatpgroup.net KEY WORDS: Alzheimer’s disease, cholinesterase inhibitor, memantine, tolerability [NOVEMBER] Psychiatry 2008 27

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Psychiatry - November 2008 Editor's Message Editorial Advisory Board Contents PsychRx Letters to the Editor Measuring Adverse Events in Psychiatry Nonsuicidal Self Injury in Adolescents Relative Tolerability of Alzheimer's Disease Treatments Biracial Identity Development and Recommendations in Therapy Depression and Cardiovascular Disease: Just an Urban Legend? Three Risk Management Basics Journal Watch Classified Advertising Information for Authors

Psychiatry - November 2008

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