Withdrawing a commonly-prescribed Alzheimer’s disease drug from people in the advanced stages of the disease doubles their risk of moving to a nursing home within a year, according to research published today in The Lancet Neurology. These findings are based on analysis of data from the DOMINO trial.
Researchers monitored 295 people with moderate to severe Alzheimer’s disease on the effects of continuing or discontinuing the drug donepezil. Currently donepezil is usually withdrawn in the later stages of the disease because of a lack of perceived benefit. The participants were randomly selected to either continue donepezil or withdraw from the drug by receiving a placebo. These 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.
In the UK, it is estimated that 527,000 people are living with Alzheimer’s disease, the most common form of dementia. Around 70% of care home residents have dementia or severe memory problems. The average cost of residential care for people with dementia is estimated to be between £30,732 and £34,424 per year. By comparison, the cost of donepezil is £21.59 per year (6p a day).
Previous findings from the DOMINO trial 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. The drug does not halt the progression of the disease, but it does help to reduce the symptoms.
The new results suggest that these benefits may translate into a delay in becoming dependent on residential care. In DOMINO, 37% of those who stopped taking donepezil moved to a care home within 12 months of stopping the drug, compared to 20% of those who continued it. Ideally more evidence is needed to confirm this study’s findings. However, as donepezil is a cheap and widely-used drug, the results are likely to change how people with moderate to severe Alzheimer’s disease are treated.