Galanthamine and donepezil are similarly effective in managing behavior and activities of daily living among patients with moderate-to-advanced Alzheimer disease, but galanthamine may be more effective in maintenance of cognition and in caregiver burden, according to an article in the July-September issue of Drugs and Aging.

The rater-blind study followed 182 patients with moderate-to-advanced Alzheimer disease who were randomized to galanthamine 24 mg daily or donepezil 10 mg daily. Both agents were generally safe and well tolerated.
Benefits for both drugs were comparable in maintaining basic activities of daily living such as bathing and grooming as measured by the Bristol Activities of Daily Living scale (the primary efficacy assessment tool). Patients’ functional abilities remained relatively constant for both treatment arms for 9 months, after which a small decline was observed. The drugs also had comparable benefits in containing abnormal behaviors such as paranoia and agitation as measured by the Neuropsychiatric Inventory.

When cognition was evaluated, there were differences between the drug groups that did not reach statistical significance. Patients on galanthamine maintained baseline levels of cognitive performance, but performance decreased significantly among patients on donepezil. However, an analysis of patients who responded to treatment (measured as lack of deterioration in Mini-Mental State Examination scores) showed that galanthamine treatment “provided significantly more sustained cognitive benefits than donepezil treatment.”

Specifically, at 12 months 55.2 percent of galanthamine patients had maintained or improved cognitive performance compared with 32.5 percent of donepezil patients. Among all patients who had moderate disease at enrollment (Mini-Mental State Examination scores 12-18, roughly 85 percent of participants), 57.9 percent of galanthamine patients maintained or improved cognitive performance compared with 29.9 percent of patients taking donepezil.

In the secondary outcome of perceived caregiver burden, people were questioned at the end of the study with the Screen for Caregiver Burden. More than two thirds of people whose participant was on galanthamine reported same or less burden (67 percent and 68 percent for frequency and severity, respectively) compared with about half the people whose participant was on donepezil (51 percent and 49 percent for frequency and severity, respectively).

“This year-long study demonstrates once again that medication is effective in slowing the progression of symptoms in Alzheimer’s disease,” said study coauthor Roger Bullock, MD. “However, while we found that there were similarities between these 2 treatments, there also were differences in cognition and caregiver burden among patients with moderate Alzheimer’s disease, which prescribers may want to take into consideration.”