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Stopping donepezil ups risk of care home admission

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Withdrawing a commonly-prescribed Alzheimer’s drug in the advanced stages of the disease doubles the risk of patients moving to a nursing home within a year, according to a UK study.

Researchers at University College London monitored 295 people with moderate-to-severe Alzheimer’s disease on the effects of continuing or discontinuing donepezil.

The drug is typically withdrawn in the later stages of the disease because of a lack of perceived benefit.

The trial participants were randomly selected to either continue donepezil or withdraw from the drug by receiving a placebo.

“We urge clinicians to consider the implications of this research and adjust their prescribing patterns accordingly”

Doug Brown

The two groups were then each divided to test the effect of receiving another dementia drug, memantine, or a placebo.

The DOMINO trial, which was funded by the Medical Research Council and Alzheimer’s Society, found that withdrawing donepezil doubled the risk of moving to a nursing home after a year.

Memantine was not found to have any effect on risk of moving to a nursing home, according to the findings published today in The Lancet Neurology journal.

In the UK, 70% of care home residents have dementia and the cost of their care is estimated to be between £30,732 and £34,424 per year. By comparison, the cost of donepezil is £21.59 per year.

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,” he said.

“We urge clinicians to consider the implications of this research and adjust their prescribing patterns accordingly,” he added.

In 2001, NICE approved the use of three anticholinesterase inhibitors – including donepezil – in the early and moderate stages of Alzheimer’s.

“Continuing with donepezil treatment provided modest benefits in cognitive function and in how well people could perform their daily activities”

Robert Howard

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 from the DOMINO trial showed that continued treatment with donepezil could 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.

Study author Professor Robert Howard said: “Our previous work showed that, even when patients had progressed to the moderate or severe stages of their dementia, continuing with donepezil 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 dependent on residential care, an event that many people dread,” he said.

An estimated 58,600 people with mild-to-moderate Alzheimer’s disease are currently taking donepezil.

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