Galantamine treatment in Alzheimer's disease: response and long-term outcome in a routine clinical setting
Open accessAbstract
BACKGROUND: In the absence of long-term, placebo-controlled studies of cholinesterase inhibitors in Alzheimer's disease (AD), analysis of the results of open-label trials becomes crucial. This study aimed to explore the three-year effects of galantamine treatment, as well as subgroups of response and adherence to treatment. METHODS: Two hundred and eighty patients with a clinical diagnosis of AD were included in the prospective, open-label, multicenter Swedish Alzheimer Treatment Study, and received galantamine treatment. Efficacy measures included cognitive tests, ie, the Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale Cognitive Subscale (ADAS-cog), functional rating (Instrumental Activities of Daily Living Scale [IADL]), and global rating. Assessments were carried out before treatment and every six months for a period of three years. K-means cluster analysis was used to identify response subgroups. RESULTS: After three years of treatment, the mean change from baseline was 2.6 points in MMSE and 5.6 points in ADAS-cog scores. Globally, half of the patients improved or remained unchanged for two years. Cluster analysis identified two response clusters. Cluster 1 included patients with low ability in ADAS-cog and IADL scores at baseline. Even though the patients in cluster 1 were older and less educated, they responded better at six months compared with patients in cluster 2. Cluster 2 included patients with better ADAS-cog and IADL scores at baseline. Patients in cluster 2 had a higher frequency of the APOE ɛ4 allele, a slower pretreatment progression rate, and remained in the study longer than those in cluster 1. Three-year completers (n = 129, 46%) received higher doses of galantamine compared with dropouts. CONCLUSION: AD patients who received long-term galantamine treatment were cognitively and globally stabilized. Subgroup response analysis identified a better short-term response in older patients with lower cognitive and functional abilities at baseline, a faster pretreatment progression rate, and a lower incidence of the APOE ɛ4 allele. The galantamine dose was higher in the population of completers.
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Longer term benefits of cholinesterase inhibitors, from 2 to 4 or more years, have been demonstrated in open-label extension and long-term prospective observational clinical cohort studies.
“Longer term benefits, from 2 to 4 or more years have been demonstrated in open-label extension 69,[88][89][90] and long-term prospective observational clinical cohort studies.[91][92][93][94][95]”
From The Alzheimer’s Disease Clinical Spectrum (2019) · cites this paper as [95]
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Self-citation
- Authors
- Wallin, Å., Minthon, & Wattmo, C.
- Affiliations
- Lund University (SE)
- Skåne University Hospital (SE)
- Corresponding author
- Wallin, Åsa
- ORCID
- Wattmo, Carina
- Venue
- Neuropsychiatric Disease and Treatment
- Publisher
- Informa UK Limited
- Published
- 2011-09
- Volume
- 7
- Pages
- 565
- ISSN
- 1176-6328 (ISSN-L)
- PMC
- PMC3191869
- OpenAlex
- W1978749566
- Cited by
- 50
- References
- 60
- Citations by year
- 2026: 1 · 2024: 3 · 2023: 5 · 2022: 4 · 2021: 4 · 2020: 3 · 2019: 2 · 2018: 1 · 2017: 3 · 2016: 1 · 2015: 9 · 2014: 4 · 2013: 7 · 2012: 3
- FWCI
- 3.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Neuropsychiatric Disease and Treatment (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion, other-oa)
- Funders
- Pfizer
- Cilag
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Pharmacology › Cholinesterase and Neurodegenerative Diseases
- Keywords
- galantamine, Alzheimer's disease, cholinesterase inhibitors, long-term treatment outcomes, treatment response subgroups, medication adherence, APOE ε4, disease progression rate, cognitive function, functional status, dose escalation
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