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Clinical Effectiveness of 10 cm^2 Rivastigmine Patch in Patients With Alzheimer's Disease

A 24-week, Multi-center, Open, Evaluation of the Clinical Effectiveness of the Once-daily 10 cm^2 Rivastigmine Patch Formulation in Patients With Probable Alzheimer's Disease (MMSE10-26)

Status
Completed
Phases
Phase 4
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00561392
Acronym
ADEPT
Enrollment
208
Registered
2007-11-21
Start date
2007-11-30
Completion date
2008-11-30
Last updated
2012-04-16

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Alzheimer's Disease

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

DRUGRivastigmine 5 and 10 cm^2 patch

Sponsors

Novartis
Lead SponsorINDUSTRY

Study design

Allocation
NON_RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE

Eligibility

Sex/Gender
ALL
Age
50 Years to No maximum
Healthy volunteers
No

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

MeasureTime frameDescription
Percentage of Participants Treated by Rivastigmine 10 cm^2 Patch for at Least 8 Weeks Who Completed the StudyBaseline to Week 24Dosages 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 StudyBaseline to Week 24Dosages 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 PatchBaseline to Week 24Dosages 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

MeasureTime frameDescription
Change From Baseline in the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the PhysicianBaseline to Week 24The 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 24Baseline and Week 24The 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 24Baseline to Week 24The 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 CaregiverBaseline t0 Week 24The 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 24Baseline to Week 24The 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 24Baseline to Week 24The 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

ArmCount
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
Total208

Withdrawals & dropouts

PeriodReasonFG000
Overall StudyAdministrative problems4
Overall StudyAdverse Event38
Overall StudyLack of Efficacy2
Overall StudyProtocol Violation1
Overall StudyWithdrawal by Subject8

Baseline characteristics

CharacteristicRivastigmine 5 and 10 cm^2 Patch
Age Continuous74 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 typeEG000
affected / at risk
deaths
Total, all-cause mortality
— / —
other
Total, other adverse events
49 / 208
serious
Total, serious adverse events
18 / 208

Outcome results

Primary

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.

ArmMeasureValue (NUMBER)
Rivastigmine 5 and 10 cm^2 PatchPercentage of Participants Treated by Rivastigmine 10 cm^2 Patch for at Least 8 Weeks Regardless Whether They Completed the Study80.8 Percentage of participants
Primary

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.

ArmMeasureValue (NUMBER)
Rivastigmine 5 and 10 cm^2 PatchPercentage of Participants Treated by Rivastigmine 10 cm^2 Patch for at Least 8 Weeks Who Completed the Study74.2 Percentage of participants
Primary

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.

ArmMeasureValue (MEAN)Dispersion
Rivastigmine 5 and 10 cm^2 PatchPercentage of Participants Who Were Compliant to the 10 cm^2 Patch95.0 Percentage of participantsStandard Deviation 28.3
Secondary

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.

ArmMeasureGroupValue (NUMBER)
Rivastigmine 5 and 10 cm^2 PatchChange From Baseline in the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the PhysicianNo change47 Participants
Rivastigmine 5 and 10 cm^2 PatchChange From Baseline in the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the PhysicianMinimal improvement25 Participants
Rivastigmine 5 and 10 cm^2 PatchChange From Baseline in the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the PhysicianModerate improvement23 Participants
Rivastigmine 5 and 10 cm^2 PatchChange From Baseline in the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the PhysicianMarked improvement15 Participants
Rivastigmine 5 and 10 cm^2 PatchChange From Baseline in the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the PhysicianMinimal decline37 Participants
Rivastigmine 5 and 10 cm^2 PatchChange From Baseline in the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the PhysicianModerate decline12 Participants
Rivastigmine 5 and 10 cm^2 PatchChange From Baseline in the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the PhysicianMarked decline5 Participants
Secondary

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.

ArmMeasureValue (MEAN)Dispersion
Rivastigmine 5 and 10 cm^2 PatchMean Change From Baseline in the Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) Score at Week 241.3 Units on a scaleStandard Deviation 12.02
Secondary

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.

ArmMeasureGroupValue (NUMBER)
Rivastigmine 5 and 10 cm^2 PatchMean Change From Baseline in the Alzheimer's Disease Cooperative Study- Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the CaregiverNo change21 Participants
Rivastigmine 5 and 10 cm^2 PatchMean Change From Baseline in the Alzheimer's Disease Cooperative Study- Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the CaregiverMinimal improvement23 Participants
Rivastigmine 5 and 10 cm^2 PatchMean Change From Baseline in the Alzheimer's Disease Cooperative Study- Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the CaregiverModerate improvement16 Participants
Rivastigmine 5 and 10 cm^2 PatchMean Change From Baseline in the Alzheimer's Disease Cooperative Study- Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the CaregiverMarked improvement15 Participants
Rivastigmine 5 and 10 cm^2 PatchMean Change From Baseline in the Alzheimer's Disease Cooperative Study- Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the CaregiverMinimal decline56 Participants
Rivastigmine 5 and 10 cm^2 PatchMean Change From Baseline in the Alzheimer's Disease Cooperative Study- Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the CaregiverModerate decline20 Participants
Rivastigmine 5 and 10 cm^2 PatchMean Change From Baseline in the Alzheimer's Disease Cooperative Study- Clinical Global Impression of Change (ADCS-CGIC) at Week 24 Assessed by the CaregiverMarked decline14 Participants
Secondary

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.

ArmMeasureValue (MEAN)Dispersion
Rivastigmine 5 and 10 cm^2 PatchMean Change From Baseline in the Mini-Mental State Examination (MMSE) Score at Week 241.3 Units on a scaleStandard Deviation 3.8
Secondary

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.

ArmMeasureValue (MEAN)Dispersion
Rivastigmine 5 and 10 cm^2 PatchMean Change From Baseline in the Mini-Zarit Inventory Score of Caregiver Burden at Week 240.4 Units on a scaleStandard Deviation 1.58
Secondary

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.

ArmMeasureValue (MEAN)Dispersion
Rivastigmine 5 and 10 cm^2 PatchMean Change From Baseline in the Trail-making Test Part A Score at Week 24-8.9 SecondsStandard Deviation 109.45

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026