36WHEN DO WE DISCONTINUE ANTIDEMENTIA DRUGS? VIEWS EXPRESSED BY CLINICIANS IN A NATIONAL SURVEY WITHIN THE UK

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Abstract

Introduction: Aim of this survey was to explore circumstances when clinicians feel it appropriate to discontinue antidementia medication and whether their practice will change with the advent of generic alternatives and evidence from the DOMINO-AD [1] study suggesting benefit of continuing these drugs in severe stages of Alzheimer's dementia.

Background: Eligibility for starting acetylcholinesterase inhibitors (AChEIs) and memantine has been scrutinised quite closely within the NHS. However, circumstances of discontinuing these medications have not been subjected to the same level of attention. The primary aim was to get an overview of the practice. The response generated provides us with valuable data towards developing a consensus regarding future prescribing of antidementia medication.

Sampling methods: An online survey was generated and circulated to clinicians on the Royal College of Psychiatrists Old Age Faculty Register. Questions covered, reasons for discontinuing AChEIs, the impact of cheaper generic alternatives and results of the DOMINO-AD [1] trial on future practice.

Results: A total of 410 responses were received. Most people (94.9%) highlighted side effects of AChEIs as the main reason for stopping. Combination therapy with memantine was suggested by 76.3% of clinicians. Sixty-five percent will be less reluctant to stop antidementia drugs in severe stages of the illness and 43% anticipate a major change with the advent of generic brands. More prescription from GPs and readiness of commissioning groups to support this practice have been suggested.

Conclusion: It is clear clinicians will continue to prescribe antidementia drugs in advanced Alzheimer's dementia irrespective of cognitive decline. A trend towards prescribing in earlier stages of the illness is also indicated. In the light of this evidence there is a need for organisations like NICE [2] to review their clinical guidelines.

References:

1. Howard R et al., N Engl J Med 2012: 366, 893–903.

2. NICE Technology Appraisal Guidance 217, March 2011.

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