Persistence with antidementia therapy in Germany: A retrospective cohort study of 567,815 patients.

Background: Despite the availability of these therapies, maintaining long-term adherence remains a significant challenge.

Objective: This retrospective cohort study aimed to investigate 12-month and 5-year persistence with antidementia drug therapy in Germany and to examine the association between demographic and clinical variables and the risk of therapy discontinuation.

Methods: Patients aged 60 years or older from the IQVIA Longitudinal Prescription Database who received an initial prescription for antidementia therapy between 2016 and 2023 (index date) were included. Time to discontinuation was estimated using the Kaplan-Meier method, and a multivariable Cox proportional hazards model was used to assess associations between predefined variables and the risk of discontinuation.

Results: The study included 567,815 patients (mean age: 80.2 years, 59.1% female). Five years after the index date, 19.8% of dementia patients were still receiving therapy, with a 12-month persistence rate of 53.1%. Cox regression models conducted for the total population revealed that younger age (<70 versus ≥90 years; HR: 1.21; 95% CI: 1.19-1.23; 71-80 years versus ≥90 years; HR: 1.13; 95% CI: 1.11-1.14) was significantly associated with an increased risk of therapy discontinuation. Initiating therapy with memantine was associated with a slightly lower risk of discontinuation compared to donepezil (HR: 0.87; 95% CI: 0.86-0.87).

Conclusion: In this study, half of the patients discontinued antidementia therapy within one year and 80% within five years. Younger age was linked to a higher risk of therapy discontinuation, while memantine therapy was associated with improved persistence, potentially reflecting better adherence among patients with more advanced dementia.