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Review
. 2007;2(1):17-32.
doi: 10.2147/ciia.2007.2.1.17.

Rivastigmine in the treatment of Alzheimer's disease: an update

Maria Luisa Onor  1 , Marianna Trevisiol, Eugenio Aguglia
Affiliations
Review

Rivastigmine in the treatment of Alzheimer's disease: an update

Maria Luisa Onor et al. Clin Interv Aging. 2007.

Abstract

Alzheimer's disease is the most common form of dementia in industrialized countries. In the European Union, about 54% of dementia cases are believed to be due to Alzheimer's disease. The condition is an age-related neurodegenerative disorder characterized by multiple cognitive deficiencies, including loss of memory, judgment, and comprehension. These manifestations are accompanied by behavioral and mood disturbances. Although no cure has yet been discovered for Alzheimer's disease, symptomatic therapies are now widely available and offer significant relief to patients and benefits to caregivers in terms of reduced care burden. At the start of the 21st century, health technology assessments recommended three agents for the symptomatic treatment of mild to moderate Alzheimer disease: rivastigmine, donepezil, and galantamine. Rivastigmine (Exelon, Novartis Basel-Switzerland) is a slowly reversible inhibitor of acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE), while donepezil (Aricept, Pfizer, New York, USA) and galantamine (Reminyl, Janssen, New Jersey, USA) show no functional inhibition of BuChE, and are considered AChE-selective, rapidly-reversible inhibitors. The efficacy of all three agents has been evaluated in large, double-blind, placebo-controlled clinical trials of up to 6 months' duration. Rivastigmine treatment in mild to moderate Alzheimer's disease improves cognition, activities of daily living, and global function.

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Figures

Figure 1
Figure 1
Percentage of patients with moderate to moderately severe AD showing clinically relevant improvements on the ADAS-cog after 52 weeks. Notes: *p < 0.05 versus original placebo group; **p = 0.116 versus original placebo group. Abbreviations: AD, Alzheimer’s disease; ADAS-cog, Alzheimer’s Disease Assessment Scale–Cognitive section.
Figure 2
Figure 2
Percentages of patients in the high- and low-dose rivastigmine group and the placebo group on the PDS after 26 weeks. Note: * p = 0.02 vs placebo Abbreviations: PDS, Progressive Deterioration Scale.
Figure 3
Figure 3
Percentages of patients in the high- and low-dose rivastigmine group and the placebo group on CIBIC-plus after 26 weeks. Abbreviations: CIBIC-p, Clinician Interview-Based Impression of Change-plus.
Figure 4
Figure 4
Common adverse events observed with rivastigmine therapy.
Figure 5
Figure 5
ADAS-cog mean change from baseline scores at week 26. Note: ▪ MHIS = 0; □ MHIS = 1 Abbreviations: ADAS-cog, Alzheimer’s Disease Assessment Scale–Cognitive section; MHIS, Modified Hachinski Ischemic Score.
Figure 6
Figure 6
PDS mean change from baseline score at week 26. Notes: ▪ MHIS = 0; □ MHIS>0. Abbreviations: MHIS, Modified Hachinski Ischemic Score; PDS, Progressive Deterioration Scale; SD, standard deviation.
Figure 7
Figure 7
CIBIC-plus mean score for population. Notes: ▪ MHIS = 0; □ MHIS > 0. Abbreviations: CIBIC-plus, Clinician Interview-Based Impression of Change-plus; MHIS, Modified Hachinski Ischemic Score; SD, standard deviation.
Figure 8
Figure 8
MMSE mean change from baseline score at week 26. Note: ▪ MHIS = 0; □ MHIS > 0. Abbreviations: MHIS, Modified Hachinski Ischemic Score; MMSE, Mini Mental State Examination; SD, standard deviation.
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References

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