August 21, 2012
Millions of people with early to moderate Alzheimer’s disease take drugs like Aricept (generic name donepezil), which are approved to help soften the symptoms of the disease early in its course. But should these drugs be continued as the disease progresses?
Many doctors stop giving Aricept and related drugs once Alzheimer’s has worsened and then start giving Namenda (memantine), a drug approved for the more advanced stages of the disease. Or they continue the patient on both drugs. But a new study of men and women with moderate to severe Alzheimer’s found that a combination of Aricept and Namenda offered no advantages over Aricept alone. The findings appeared in the New England Journal of Medicine.
For the study, researchers divided 295 patients with moderate to severe disease who were already taking Aricept into four groups. Over the next year, some continued to take Aricept; some continued to take Aricept and started taking Namenda; some stopped Aricept and started taking Namenda; and the fourth group stopped taking Aricept and took placebo pills.
Those who continued to take Aricept as their Alzheimer’s progressed showed a moderate beneficial effect on thinking and day-to-day activities of living compared to those who took a placebo. But starting Namenda in patients who had been taking Aricept for some time offered no benefits over Aricept alone in this study. Namenda alone also offered some benefits over placebo, though not as much as Aricept did. The study did not include patients who had been taking both drugs, donepezil and Namenda, for some time.
The overall effects of the drugs were generally modest, and teasing out the precise benefits of each is difficult. A separate analysis of the data found that both drugs offered benefits, and many doctors will likely continue to offer both to those with more advanced Alzheimer’s.
But until now, there had been no clear evidence that continuing on drugs like Aricept offered benefits for patients with advanced Alzheimer’s. And while Aricept and related drugs can produce modest improvements, though they do not stop the downward progression of disease.
“For the first time, we have robust and compelling evidence that treatment with these drugs can continue to help patients at the later, more severe stages of the disease,” said Dr. Robert Howard, lead author from the Institute of Psychiatry at King’s College in London, where the study was conducted. “We observed that patients who continued taking donepezil were better able to remember, understand, communicate and perform daily tasks for at least a year longer than those who stopped taking the drugs.”
The researchers found that patients who continued to take Aricept had less decline in memory, orientation and language function than those who took a placebo drug. They also were better able to carry out simple daily tasks of living and self-care, as noted by patients themselves as well as their caregivers and doctors.
Both Aricept and Namenda will soon be available in less expensive generic forms, offering hope to the more than 38 million Alzheimer’s patients worldwide, Dr. Howard noted.
Robert Howard, Rupert McShane, James Lindesay, et al: “Donepezil and Memantine for Moderate-to-Severe Alzheimer’s Disease.” New England Journal of Medicine, Vol. 366, March 8, 2012, pages 893-903.