Persistence With Antidementia Therapy in Germany: A Retrospective Cohort Study of 212,850 Patients
Author(s)
Miriam Claire Guba-Menzel, MSc1, Jens Bohlken, PhD, MD2, Karel Kostev, MA, DrPH, MD3.
1Epidemiology, IQVIA, Cologne, Germany, 2Faculty of Medicine, Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany, 3Senior Scientific Principal, IQVIA Commercial GmbH & Co. OHG, Franfurt am Main, Germany.
1Epidemiology, IQVIA, Cologne, Germany, 2Faculty of Medicine, Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany, 3Senior Scientific Principal, IQVIA Commercial GmbH & Co. OHG, Franfurt am Main, Germany.
OBJECTIVES: This retrospective cohort study aimed to investigate 3-year persistence with antidementia drug therapy in Germany and examine the association between demographic and clinical variables and the risk of therapy discontinuation.
METHODS: The study utilized the IQVIA Longitudinal Prescription Database (LRx), which captures over 80% of prescriptions reimbursed by statutory health insurance in Germany. Patients aged 60 years or older who received an initial prescription for antidementia therapy between January 2016 and December 2023 (index date) were included. Time to discontinuation was estimated using the Kaplan-Meier method, and a multivariable Cox proportional hazards model was used to evaluate associations between predefined variables and the risk of discontinuation.
RESULTS: The study included 212,850 patients (mean age: 80.9 years, SD: 6.7; 58.5% female). Within three years of the index date, 66.6% of patients discontinued therapy. Regression analysis showed that younger age (HR: 1.17; 95% CI: 1.14-1.21 for age 60-69 vs. 90+), initial treatment with rivastigmine (HR: 1.24; 95% CI: 1.22-1.26) as well as female sex (HR: 1.05; 95% CI: 1.04-1.06) were associated with a slightly increased risk of therapy discontinuation. The association between rivastigmine use and discontinuation increased with age, from HR: 1.07 (95% CI: 1.01-1.13) in the 60-69 age group to HR: 1.44 (95% CI: 1.36-1.53) in those aged 90 and older. Initiation of therapy by a neuropsychiatrist was associated with a reduced risk of discontinuation in the 90+ age group (HR: 0.92; 95% CI: 0.88-0.96).
CONCLUSIONS: In this large-scale retrospective cohort study, two-thirds of patients discontinued antidementia therapy within three years, with younger age, female sex, and use of rivastigmine, donepezil, or galantamine linked to higher discontinuation risks. Initiation by a neuropsychiatrist was associated with improved persistence among the oldest patients, highlighting the potential impact of prescriber specialty on long-term therapy adherence.
METHODS: The study utilized the IQVIA Longitudinal Prescription Database (LRx), which captures over 80% of prescriptions reimbursed by statutory health insurance in Germany. Patients aged 60 years or older who received an initial prescription for antidementia therapy between January 2016 and December 2023 (index date) were included. Time to discontinuation was estimated using the Kaplan-Meier method, and a multivariable Cox proportional hazards model was used to evaluate associations between predefined variables and the risk of discontinuation.
RESULTS: The study included 212,850 patients (mean age: 80.9 years, SD: 6.7; 58.5% female). Within three years of the index date, 66.6% of patients discontinued therapy. Regression analysis showed that younger age (HR: 1.17; 95% CI: 1.14-1.21 for age 60-69 vs. 90+), initial treatment with rivastigmine (HR: 1.24; 95% CI: 1.22-1.26) as well as female sex (HR: 1.05; 95% CI: 1.04-1.06) were associated with a slightly increased risk of therapy discontinuation. The association between rivastigmine use and discontinuation increased with age, from HR: 1.07 (95% CI: 1.01-1.13) in the 60-69 age group to HR: 1.44 (95% CI: 1.36-1.53) in those aged 90 and older. Initiation of therapy by a neuropsychiatrist was associated with a reduced risk of discontinuation in the 90+ age group (HR: 0.92; 95% CI: 0.88-0.96).
CONCLUSIONS: In this large-scale retrospective cohort study, two-thirds of patients discontinued antidementia therapy within three years, with younger age, female sex, and use of rivastigmine, donepezil, or galantamine linked to higher discontinuation risks. Initiation by a neuropsychiatrist was associated with improved persistence among the oldest patients, highlighting the potential impact of prescriber specialty on long-term therapy adherence.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH176
Topic
Epidemiology & Public Health, Study Approaches
Disease
Mental Health (including addition), Neurological Disorders