Alzheimer's Disease
Conditions
Keywords
Alzheimer's Disease, Rivastigmine, Patch
Brief summary
This study evaluated the safety and efficacy of 10 cm\^2 rivastigmine patch in patients with Alzheimer Disease (MMSE 10-26). The primary objective was the percentage of patients who stayed on the target size of 10 cm\^2 for at least 8 weeks. This proportion was then compared to historical data of the percentage of patients who could reach a rivastigmine capsule target dose of 12 mg and stay on it at least 8 weeks.
Interventions
Sponsors
Study design
Eligibility
Inclusion criteria
* Males, and females not of child-bearing potential (surgically sterile or at least one year postmenopausal), of at least 50 years of age * Probable Alzheimer's disease according to the NINCDS-ADRDA (National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association) and DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) criteria * MMSE (Mini-Mental State Examination) score of \> 10 and \< 26 * Patients initiating therapy for the first time with a cholinesterase inhibitor (patients prescribed both rivastigmine and memantine are allowed) * Patients who failed to benefit from previous cholinesterase inhibitor treatment
Exclusion criteria
* Patients not treated according to the product monograph for rivastigmine capsules * patients involved in a clinical trial * Current diagnosis of an active skin lesion/disorder that would prevent accurate assessment of the adhesion and potential skin irritation of the patch (e.g., atopic dermatitis, wounded or scratched skin in the area of the patch application) Other protocol-defined
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percentage of Participants Treated by Rivastigmine 10 cm^2 Patch for at Least 8 Weeks Who Completed the Study | Baseline to Week 24 | Dosages of study medication prescribed to and taken by the patient was assessed in a Drug Administration Record with start date, end date, dosage and reason for dose adjustment (if applicable). Data was amended by counting the returned medication at the study visits and information by the caregiver. |
| Percentage of Participants Treated by Rivastigmine 10 cm^2 Patch for at Least 8 Weeks Regardless Whether They Completed the Study | Baseline to Week 24 | Dosages of study medication prescribed to and taken by the patient was assessed in a Drug Administration Record with start date, end date, dosage and reason for dose adjustment (if applicable). Data was amended by counting the returned medication at the study visits and information by the caregiver. |
| Percentage of Participants Who Were Compliant to the 10 cm^2 Patch | Baseline to Week 24 | Dosages of study medication prescribed to and taken by the patient was assessed in a Drug Administration Record with start date, end date, dosage and reason for dose adjustment (if applicable). Data was amended by counting the returned medication at the study visits and information by the caregiver. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change From Baseline in the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the Physician | Baseline to Week 24 | The ADCS-CGIC is an assessment tool to make a judgment of change in a patient's condition. Change is derived from comparing an assessment performed at baseline versus an assessment at the end of the study. Change is categorized into 1 of 7 categories: No change; minimal, moderate, or marked improvement; or minimal, moderate, or marked decline. Results are reported as number of patients in the indicated change category. |
| Mean Change From Baseline in the Mini-Mental State Examination (MMSE) Score at Week 24 | Baseline and Week 24 | The MMSE is a brief, practical screening test for cognitive dysfunction. The test consists of five sections (orientation, registration, attention-calculation, recall, and language); the total score can range from 0 to 30, with a higher score indicating better function. A positive change score indicates improvement. |
| Mean Change From Baseline in the Mini-Zarit Inventory Score of Caregiver Burden at Week 24 | Baseline to Week 24 | The Mini-Zarit Inventory assesses the burden of a caregiver in caring for a patient. The inventory is composed of 5 questions which are rated according to the following answers: 0 = never, ½ = sometimes, 1 = often. The ratings on the 5 questions are added together resulting in a total score of 0 to 7 with a higher score indicating greater caregiver burden. A negative change score indicates reduced burden. |
| Mean Change From Baseline in the Alzheimer's Disease Cooperative Study- Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the Caregiver | Baseline t0 Week 24 | The ADCS-CGIC is an assessment tool to make a judgment of change in a patient's condition. Change is derived from comparing an assessment performed at baseline versus an assessment at the end of the study. Change is categorized into 1 of 7 categories: No change; minimal, moderate, or marked improvement; or minimal, moderate, or marked decline. |
| Mean Change From Baseline in the Trail-making Test Part A Score at Week 24 | Baseline to Week 24 | The Trail-making test is a neuropsychological test of visual attention and task switching. The task requires a subject to 'connect-the-dots' of 25 consecutive numbers (1,2,3, etc.) on a sheet of paper or computer screen. The goal of the subject is to finish the test as quickly as possible, and the time taken to complete the test is used as the primary performance metric (in seconds). The maximum time allowed is 300 seconds. A negative change score indicates improvement. |
| Mean Change From Baseline in the Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) Score at Week 24 | Baseline to Week 24 | The ADCS-ADL scale is composed of 23 items developed to assess a patient's performance of both basic and instrumental activities of daily living such as those necessary for personal care, communicating and interacting with other people, maintaining a household, conducting hobbies and interests, as well as making judgments and decisions. Responses for each item will be obtained from the caregiver through an interview. The range for the total ADCS-ADL score is 0 to 78; a higher score indicates a more self-sufficient individual. A positive change score indicates improvement. |
Countries
Germany
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Rivastigmine 5 and 10 cm^2 Patch For the 1st 4 weeks of this 24 week study, patients were administered rivastigmine transdermally once daily via a 5 cm\^2 patch. After the Week 4 assessment, patients were administered rivastigmine transdermally once daily via a 10 cm\^2 patch, with adjustments as necessary for safety and tolerability. | 208 |
| Total | 208 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Administrative problems | 4 |
| Overall Study | Adverse Event | 38 |
| Overall Study | Lack of Efficacy | 2 |
| Overall Study | Protocol Violation | 1 |
| Overall Study | Withdrawal by Subject | 8 |
Baseline characteristics
| Characteristic | Rivastigmine 5 and 10 cm^2 Patch |
|---|---|
| Age Continuous | 74 years STANDARD_DEVIATION 7.7 |
| Region of Enrollment Germany | 208 participants |
| Sex: Female, Male Female | 110 Participants |
| Sex: Female, Male Male | 98 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | — / — |
| other Total, other adverse events | 49 / 208 |
| serious Total, serious adverse events | 18 / 208 |
Outcome results
Percentage of Participants Treated by Rivastigmine 10 cm^2 Patch for at Least 8 Weeks Regardless Whether They Completed the Study
Dosages of study medication prescribed to and taken by the patient was assessed in a Drug Administration Record with start date, end date, dosage and reason for dose adjustment (if applicable). Data was amended by counting the returned medication at the study visits and information by the caregiver.
Time frame: Baseline to Week 24
Population: The Intent-to-Treat (ITT) population was defined as all randomized patients who were administered at least one dose of study medication and were assessed at baseline and post-baseline for efficacy at least 1 time.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Rivastigmine 5 and 10 cm^2 Patch | Percentage of Participants Treated by Rivastigmine 10 cm^2 Patch for at Least 8 Weeks Regardless Whether They Completed the Study | 80.8 Percentage of participants |
Percentage of Participants Treated by Rivastigmine 10 cm^2 Patch for at Least 8 Weeks Who Completed the Study
Dosages of study medication prescribed to and taken by the patient was assessed in a Drug Administration Record with start date, end date, dosage and reason for dose adjustment (if applicable). Data was amended by counting the returned medication at the study visits and information by the caregiver.
Time frame: Baseline to Week 24
Population: The Intent-to-Treat (ITT) population was defined as all randomized patients who were administered at least one dose of study medication and were assessed at baseline and post-baseline for efficacy at least 1 time.
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Rivastigmine 5 and 10 cm^2 Patch | Percentage of Participants Treated by Rivastigmine 10 cm^2 Patch for at Least 8 Weeks Who Completed the Study | 74.2 Percentage of participants |
Percentage of Participants Who Were Compliant to the 10 cm^2 Patch
Dosages of study medication prescribed to and taken by the patient was assessed in a Drug Administration Record with start date, end date, dosage and reason for dose adjustment (if applicable). Data was amended by counting the returned medication at the study visits and information by the caregiver.
Time frame: Baseline to Week 24
Population: The Intent-to-Treat (ITT) population was defined as all randomized patients who were administered at least one dose of study medication and were assessed at baseline and post-baseline for efficacy at least 1 time.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Rivastigmine 5 and 10 cm^2 Patch | Percentage of Participants Who Were Compliant to the 10 cm^2 Patch | 95.0 Percentage of participants | Standard Deviation 28.3 |
Change From Baseline in the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the Physician
The ADCS-CGIC is an assessment tool to make a judgment of change in a patient's condition. Change is derived from comparing an assessment performed at baseline versus an assessment at the end of the study. Change is categorized into 1 of 7 categories: No change; minimal, moderate, or marked improvement; or minimal, moderate, or marked decline. Results are reported as number of patients in the indicated change category.
Time frame: Baseline to Week 24
Population: The Intent-to-Treat (ITT) population was defined as all randomized patients who were administered at least one dose of study medication and were assessed at baseline and post-baseline for efficacy at least 1 time.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Rivastigmine 5 and 10 cm^2 Patch | Change From Baseline in the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the Physician | No change | 47 Participants |
| Rivastigmine 5 and 10 cm^2 Patch | Change From Baseline in the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the Physician | Minimal improvement | 25 Participants |
| Rivastigmine 5 and 10 cm^2 Patch | Change From Baseline in the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the Physician | Moderate improvement | 23 Participants |
| Rivastigmine 5 and 10 cm^2 Patch | Change From Baseline in the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the Physician | Marked improvement | 15 Participants |
| Rivastigmine 5 and 10 cm^2 Patch | Change From Baseline in the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the Physician | Minimal decline | 37 Participants |
| Rivastigmine 5 and 10 cm^2 Patch | Change From Baseline in the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the Physician | Moderate decline | 12 Participants |
| Rivastigmine 5 and 10 cm^2 Patch | Change From Baseline in the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the Physician | Marked decline | 5 Participants |
Mean Change From Baseline in the Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) Score at Week 24
The ADCS-ADL scale is composed of 23 items developed to assess a patient's performance of both basic and instrumental activities of daily living such as those necessary for personal care, communicating and interacting with other people, maintaining a household, conducting hobbies and interests, as well as making judgments and decisions. Responses for each item will be obtained from the caregiver through an interview. The range for the total ADCS-ADL score is 0 to 78; a higher score indicates a more self-sufficient individual. A positive change score indicates improvement.
Time frame: Baseline to Week 24
Population: The Intent-to-Treat (ITT) population was defined as all patients who were administered at least one dose of study medication and were assessed for efficacy at least 1 time.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Rivastigmine 5 and 10 cm^2 Patch | Mean Change From Baseline in the Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) Score at Week 24 | 1.3 Units on a scale | Standard Deviation 12.02 |
Mean Change From Baseline in the Alzheimer's Disease Cooperative Study- Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the Caregiver
The ADCS-CGIC is an assessment tool to make a judgment of change in a patient's condition. Change is derived from comparing an assessment performed at baseline versus an assessment at the end of the study. Change is categorized into 1 of 7 categories: No change; minimal, moderate, or marked improvement; or minimal, moderate, or marked decline.
Time frame: Baseline t0 Week 24
Population: The Intent-to-Treat (ITT) population was defined as all randomized patients who were administered at least one dose of study medication and were assessed at baseline and post-baseline for efficacy at least 1 time.
| Arm | Measure | Group | Value (NUMBER) |
|---|---|---|---|
| Rivastigmine 5 and 10 cm^2 Patch | Mean Change From Baseline in the Alzheimer's Disease Cooperative Study- Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the Caregiver | No change | 21 Participants |
| Rivastigmine 5 and 10 cm^2 Patch | Mean Change From Baseline in the Alzheimer's Disease Cooperative Study- Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the Caregiver | Minimal improvement | 23 Participants |
| Rivastigmine 5 and 10 cm^2 Patch | Mean Change From Baseline in the Alzheimer's Disease Cooperative Study- Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the Caregiver | Moderate improvement | 16 Participants |
| Rivastigmine 5 and 10 cm^2 Patch | Mean Change From Baseline in the Alzheimer's Disease Cooperative Study- Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the Caregiver | Marked improvement | 15 Participants |
| Rivastigmine 5 and 10 cm^2 Patch | Mean Change From Baseline in the Alzheimer's Disease Cooperative Study- Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the Caregiver | Minimal decline | 56 Participants |
| Rivastigmine 5 and 10 cm^2 Patch | Mean Change From Baseline in the Alzheimer's Disease Cooperative Study- Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the Caregiver | Moderate decline | 20 Participants |
| Rivastigmine 5 and 10 cm^2 Patch | Mean Change From Baseline in the Alzheimer's Disease Cooperative Study- Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the Caregiver | Marked decline | 14 Participants |
Mean Change From Baseline in the Mini-Mental State Examination (MMSE) Score at Week 24
The MMSE is a brief, practical screening test for cognitive dysfunction. The test consists of five sections (orientation, registration, attention-calculation, recall, and language); the total score can range from 0 to 30, with a higher score indicating better function. A positive change score indicates improvement.
Time frame: Baseline and Week 24
Population: The Intent-to-Treat (ITT) population was defined as all randomized patients who were administered at least one dose of study medication and were assessed at baseline and post-baseline for efficacy at least 1 time.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Rivastigmine 5 and 10 cm^2 Patch | Mean Change From Baseline in the Mini-Mental State Examination (MMSE) Score at Week 24 | 1.3 Units on a scale | Standard Deviation 3.8 |
Mean Change From Baseline in the Mini-Zarit Inventory Score of Caregiver Burden at Week 24
The Mini-Zarit Inventory assesses the burden of a caregiver in caring for a patient. The inventory is composed of 5 questions which are rated according to the following answers: 0 = never, ½ = sometimes, 1 = often. The ratings on the 5 questions are added together resulting in a total score of 0 to 7 with a higher score indicating greater caregiver burden. A negative change score indicates reduced burden.
Time frame: Baseline to Week 24
Population: The Intent-to-Treat (ITT) population was defined as all randomized patients who were administered at least one dose of study medication and were assessed at baseline and post-baseline for efficacy at least 1 time.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Rivastigmine 5 and 10 cm^2 Patch | Mean Change From Baseline in the Mini-Zarit Inventory Score of Caregiver Burden at Week 24 | 0.4 Units on a scale | Standard Deviation 1.58 |
Mean Change From Baseline in the Trail-making Test Part A Score at Week 24
The Trail-making test is a neuropsychological test of visual attention and task switching. The task requires a subject to 'connect-the-dots' of 25 consecutive numbers (1,2,3, etc.) on a sheet of paper or computer screen. The goal of the subject is to finish the test as quickly as possible, and the time taken to complete the test is used as the primary performance metric (in seconds). The maximum time allowed is 300 seconds. A negative change score indicates improvement.
Time frame: Baseline to Week 24
Population: The Intent-to-Treat (ITT) population was defined as all randomized patients who were administered at least one dose of study medication and were assessed at baseline and post-baseline for efficacy at least 1 time.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Rivastigmine 5 and 10 cm^2 Patch | Mean Change From Baseline in the Trail-making Test Part A Score at Week 24 | -8.9 Seconds | Standard Deviation 109.45 |