Edward Chia-Cheng Lai1,2, Monera B Wong3, Isao Iwata4,5, Yinghong Zhang1, Cheng-Yang Hsieh2,6, Yea-Huei Kao Yang2,4, Soko Setoguchi1,7. 1. Duke Clinical Research Institute, School of Medicine, Duke University, Durham, North Carolina. 2. School of Pharmacy and Institute of Clinical Pharmacy and Pharmaceutical Sciences, National Cheng Kung University, Tainan, Taiwan. 3. Geriatric Medicine Unit, Massachusetts General Hospital, Boston, Massachusetts. 4. Health Outcome Research Center, National Cheng Kung University, Tainan, Taiwan. 5. Division of Geriatric Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 6. Department of Neurology, Tainan Sin-Lau Hospital, Tainan, Taiwan. 7. Department of Medicine, School of Medicine, Duke University, Durham, North Carolina.
Abstract
OBJECTIVES: To compare the risk of pneumonia in older adults receiving donepezil, galantamine, or rivastigmine for dementia. DESIGN: Retrospective cohort study. SETTING: Nationally representative 5% sample of Medicare databases. PARTICIPANTS: Medicare beneficiaries aged 65 and older who newly initiated cholinesterase inhibitor therapy between 2006 and 2009. MEASUREMENTS: Pneumonia, defined as the presence of a diagnosis code for pneumonia as the primary diagnosis on an inpatient claim or on an emergency department claim followed by dispensing of appropriate antibiotics. Cox proportional hazards models were used to estimate the risk of pneumonia. Subgroup analyses and sensitivity analyses were conducted using alternative pneumonia definitions and adjustments using high-dimensional propensity scores to test the robustness of the results. RESULTS: The mean age of 35,570 new users of cholinesterase inhibitors (30,174 users of donepezil, 1,176 users of galantamine, 4,220 users of rivastigmine) was 82; 75% were women, and 82% were white. The cumulative incidence of pneumonia was 51.9 per 1,000 person-years. The risk of pneumonia for rivastigmine users was 24% lower than that of donepezil users (hazard ratio (HR)=0.75, 95% confidence interval (CI)=0.60-0.93). Risk in galantamine users (HR=0.87, 95% CI=0.62-1.23) was not significantly different from risk in donepezil users. Results of subgroup and sensitivity analyses were similar to the primary results. CONCLUSION: The risk of pneumonia was lower in individuals receiving rivastigmine than in those receiving donepezil. Additional studies are needed to confirm the findings of pneumonia risk between the oral and transdermal forms of rivastigmine and in users of galantamine.
OBJECTIVES: To compare the risk of pneumonia in older adults receiving donepezil, galantamine, or rivastigmine for dementia. DESIGN: Retrospective cohort study. SETTING: Nationally representative 5% sample of Medicare databases. PARTICIPANTS: Medicare beneficiaries aged 65 and older who newly initiated cholinesterase inhibitor therapy between 2006 and 2009. MEASUREMENTS: Pneumonia, defined as the presence of a diagnosis code for pneumonia as the primary diagnosis on an inpatient claim or on an emergency department claim followed by dispensing of appropriate antibiotics. Cox proportional hazards models were used to estimate the risk of pneumonia. Subgroup analyses and sensitivity analyses were conducted using alternative pneumonia definitions and adjustments using high-dimensional propensity scores to test the robustness of the results. RESULTS: The mean age of 35,570 new users of cholinesterase inhibitors (30,174 users of donepezil, 1,176 users of galantamine, 4,220 users of rivastigmine) was 82; 75% were women, and 82% were white. The cumulative incidence of pneumonia was 51.9 per 1,000 person-years. The risk of pneumonia for rivastigmine users was 24% lower than that of donepezil users (hazard ratio (HR)=0.75, 95% confidence interval (CI)=0.60-0.93). Risk in galantamine users (HR=0.87, 95% CI=0.62-1.23) was not significantly different from risk in donepezil users. Results of subgroup and sensitivity analyses were similar to the primary results. CONCLUSION: The risk of pneumonia was lower in individuals receiving rivastigmine than in those receiving donepezil. Additional studies are needed to confirm the findings of pneumonia risk between the oral and transdermal forms of rivastigmine and in users of galantamine.
Authors: Gordon Wilcock; Ian Howe; Hilary Coles; Sean Lilienfeld; Luc Truyen; Young Zhu; Roger Bullock; Paul Kershaw Journal: Drugs Aging Date: 2003 Impact factor: 3.923
Authors: Wilma Knol; Rob J van Marum; Paul A F Jansen; Patrick C Souverein; Alfred F A M Schobben; Antoine C G Egberts Journal: J Am Geriatr Soc Date: 2008-02-07 Impact factor: 5.562