Politics and Medicine - therapeutics initative letter #56: Alzheimers drugs what is the evidence?

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therapeutics initative letter #56: Alzheimers drugs what is the evidence?

fresh~horses

2005-08-22, 5:54 pm

August 2005 issue (#56) of the Therapeutics Letter: "Drugs for
Alzheimer's Disease" has just been published on the Therapeutics
Initiative web site at:

http://www.ti.ubc.ca/pages/letter56.htm

In this Therapeutics Letter we summarize the currently available
evidence on
the three acetylcholinesterase inhibitors (AChE-I) licensed for
Alzheimer's
Disease (AD) in Canada: donepezil (Aricept), rivastigmine (Exelon), and
galantamine (Reminyl), as well as the neuro-receptor antagonist
memantine
(Ebixa). We conclude that:

* Donepezil has not been demonstrated to improve outcomes of importance
to
patients and caregivers (e.g. institutionalization or disability).
Rivastigmine and galantamine have not been studied for these outcomes.

* AChE-I cause gastrointestinal, muscular, and other adverse effects
and
likely increase serious adverse events.

* There is no evidence that stopping AChE-I treatment is harmful.

* In advanced AD, memantine has not been demonstrated to improve
outcomes of
importance to patients and caregivers.

Evelyn Ruut

2005-08-22, 10:55 pm

"Bud" <Bud@romance.org> wrote in message
news:s-qdnZ2dnZ2m5A38nZ2dnUn8l96dnZ2dRVn-0p2dnZ0@comcast.com...
>
> The key words...
> There is no 'improved outcome of importance' in this disease. It is a
> progressive and eventually terminal condition. Most psychiatrists decry
> the medicines as having a very poor cost/benefit ratio and recommend
> either stopping them or never starting them. "Let nature take it's
> course.", I've been advised more than once.
> That said, my wife has been taking Aricept and Memantine for years and is,
> although now in the later stages of the disease, still taking them. I
> shall continue them. I am sure they are doing little for her now and I
> have been told many times that I am only delaying the inevitable. Also
> that it is like not pulling a feeding tube in a patient with little or no
> brain function. Well, my philosophy is all that life is anyway is just
> delaying the inevitable death. As long as she is concious, comfortable and
> able to swallow I shall have those medications given despite the high
> cost. How much is an existance worth? YMMV but that's my take on the
> reports of this nature.

Well said, Bud.

My mother in law was on Aricept for a couple of years and the doctor wanted
to switch her to something else. The decline in her abilities was
IMMEDIATE and NOTICEABLE. After a week of increased confusion and worsened
incontinence we called and begged the doctor to put her back on Aricept.
The improvement was again, IMMEDIATE and NOTICEABLE.

Proof enough for me.

I hate these people who come in with these stories trying to tell people not
to take this or that drug. What counts is if the drug works for YOUR loved
one. I have no idea what these peoples agendas are. It has to have a
certain nasty karma to prevent people from taking a drug that might really
help them.
--

Best Regards,
Evelyn

(to reply to me personally, remove 'sox')

Alan Meyer

2005-08-23, 10:59 pm

Bud wrote:
....
> That said, my wife has been taking Aricept and Memantine for years and
> is, although now in the later stages of the disease, still taking them.
> I shall continue them. I am sure they are doing little for her now and I
> have been told many times that I am only delaying the inevitable. Also
> that it is like not pulling a feeding tube in a patient with little or
> no brain function. Well, my philosophy is all that life is anyway is
> just delaying the inevitable death. As long as she is concious,
> comfortable and able to swallow I shall have those medications given
> despite the high cost. How much is an existance worth? YMMV but that's
> my take on the reports of this nature.

These problems are so difficult to analyze.

Did the drug do any good? Is it still doing any good?
Is it worth the cost?

How are we to know?

Some of the people here report that they have seen clear
effects. I could not tell any good effect of Aricept on either
my father or my mother-in-law, and did see bad side effects
in my MIL.

I think the best policy may be to observe for yourself.

If the patient has never had the drugs, try them and
observe. If the patient is taking the drugs now, withdraw
them and observe. A number of people have indicated that
when they withdrew the drugs and saw a slide in capacity,
restoring the drugs restored the capacity.

One of the things I dislike about expensive, proprietary
drugs is that they suck tons of money, and tons of profits,
out of families in need and out of the health care system
that we all pay for with medicare taxes and insurance
premiums.

Providing expensive drugs to people who need them is a
good deed. But withdrawing expensive drugs from people
who are not benefitting from them is also a good deed.
People shouldn't feel guilty about withdrawing drugs for
a trial period to see if the patient does just as well
without them.

Anyway, that's my 2 cents.

Alan

Anthony Shipley

2005-08-25, 10:57 pm

Bud <Bud@romance.org> [WA] wrote:

>Sorry to be so verbose but I'm generally withdrawn and probably won't
>elaboraste again. Thanks for everyone's patience, understanding and
>advice/thoughts. Y'all have a good 'un now, y'heah? ;-)

Elaboraste?

Is it in any dictionary? It certainly sounds like it should be :-)

--
2 + 2 = 5 for sufficiently large values of 2.