Does Stopping Donepezil for Alzheimer Disease Increase Nursing Home Placement?

Jennifer Rose V. Molano, MD reviewing Howard R et al. Lancet Neurol 2015 Oct 26.

Only during the first year after discontinuation, according to secondary-outcome data from the DOMINO-AD trial

In the DOMINO-AD randomized trial, community-dwelling patients with moderate-to-severe Alzheimer disease (Mini-Mental State Examination score, 5–13) who continued the daily 10-mg donepezil treatment they'd been taking for at least 6 weeks had better cognitive and functional outcomes at 1 year than did patients who stopped donepezil, added memantine, or substituted memantine for the donepezil (NEJM JW Neurology Apr 2012 and N Engl J Med 2012; 366:893 and 957). Researchers have now analyzed the secondary outcome of nursing-home placement for the four DOMINO-AD randomized groups (295 participants in all). Nursing-home placements were determined using a standardized inventory during the first year, then by caregiver report every 6 months thereafter.

Of the 295 trial participants, 162 (roughly evenly divided among the 4 randomized groups) were placed in a nursing home within 4 years. Sixty-six participants died before nursing-home placement, and 26 died after placement; time of death did not differ significantly among the four groups. In the first year, nursing-home placement was significantly more common in the two groups that had stopped donepezil than in the two groups that continued taking it (hazard ratio, 2.09), but this difference did not persist during the remaining 3 years. Memantine use had no effect on nursing-home placement.

Citation(s):

Howard R et al. Nursing home placement in the Donepezil and Memantine in Moderate to Severe Alzheimer's Disease (DOMINO-AD) trial: Secondary and post-hoc analyses. Lancet Neurol 2015 Oct 26; [e-pub].