Withdrawing donepezil, a commonly-prescribed Alzheimer’s disease drug, from people in the advanced stages of the disease doubles their risk of being placed in a nursing home within a year.
That’s according to new research conducted by scientists at University College London (UCL). The scientists followed 295 people with moderate to severe Alzheimer’s disease to monitor the effects of continuing or discontinuing the donepezil. The drug is typically withdrawn in the later stages of the disease because of a lack of perceived benefit by clinicians. The participants were randomly selected to either continue donepezil or withdraw from the drug by receiving a placebo. These two groups were then each divided to test the effect of receiving another dementia drug, memantine, or a placebo.
The DOMINO trial found that withdrawing donepezil doubled the risk of nursing home placement after a year. Memantine was not found to have any effect on risk of nursing home placement.
Delay in becoming dependant on residential care
Robert Howard, professor of old age psychiatry at UCL, said, “Our previous work showed that, even when patients had progressed to the moderate or severe stages of their dementia, continuing with donezepil treatment provided modest benefits in cognitive function and in how well people could perform their daily activities.
“Our new results show that these benefits translate into a delay in becoming dependant on residential care, a point that many of us dread. We are all impatient for the advent of true disease-modifying drugs that can slow or halt the Alzheimer process, but donepezil is available right now and at modest cost.”
Dr Doug Brown, director of research and development at the Alzheimer’s Society, said, “With no new treatments for Alzheimer’s disease in over a decade, it is absolutely crucial that we make the most of the drugs we have available. Residential care can be the best option for someone whose care needs are complex, but it is important that we continue to find better ways to support people with dementia to remain in their own homes for longer.
“These robust findings are of real significance to people with dementia and their families who want to continue living at home for as long as possible. We urge clinicians to consider the implications of this research and adjust their prescribing patterns accordingly.”
Donepezil can provide cognitive and functional benefits
In 2001, NICE approved the use of three anticholinesterase inhibitors – which included donepezil – in the early and moderate stages of Alzheimer’s. The drugs had been found to reduce the symptoms of Alzheimer’s and were the first treatments to be approved for the disease.
Previous results published from the DOMINO trial in 2012 were the first to show that continued treatment with donepezil can provide cognitive and functional benefits in people with moderate to severe Alzheimer’s disease, such as retaining the ability to eat, dress and go shopping more independently.
