Age and Ageing Advance Access originally published online on January 25, 2007
Age and Ageing 2007 36(2):234; doi:10.1093/ageing/afl169
Comparative analysis of mortality in patients with Alzheimer's disease treated with donepezil and galantamine
SIR—We read with interest, López-Pousa et al.'s article ‘Comparative analysis of mortality in patients with Alzheimer's disease treated with donepezil or galantamine’ [1]. This is interesting information providing data on the real world clinical effects of AChEIs, that have been the subject of controversy regarding its benefit/risk ratio [2, 3]. The authors conclude that the duration and the dose of donepezil or galantamine are not related to an increase in mortality. Some points should be discussed in order to clarify the data leading to such a conclusion.Regarding mortality, the primary aim of the study, the authors compare the mortality rates irrespective of the follow-up time. We believe that a true time-to-event analysis, using, e.g. Kaplan-Meier or Cox proportional hazard methods, would yield the most correct results. Additionally, the death rate was estimated taking into account the deaths occurring in patients who continued the AChEI as well as those occurring in patients who abandoned the AChEI, mimicking an ITT (intention to treat) analysis. As the aim of the study is to compare mortality among patients treated with these two AChEIs, the survival time analysis should applied only be to the cohort of patients who continue treatment either with donepezil (16 deceased among 163 patients continuing treatment) or galantamine (13 deceased among 116 continuing treatment). On the other hand, the total number of donepezil treated patients in Table 1 of the original publication is 197 instead of 202 as it appears in the text and in Figure 1 of the original publication. This discrepancy should be reviewed and taken into consideration whenever a survival time analysis is performed.
- We declare that we have no conflict of interest.
- Dolors Capellà, Xavier Vidal
- Universitat Autònoma de Barcelona
- Hospital Universitari Vall d'Hebron
- Fundació Institut Català de Farmacología
- Dolors Capellà, Xavier Vidal
Servei de Farmacologia Clínica, Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron, 117-127, 08035 Barcelona, Spain
xvg{at}icf.uab.es
* To whom correspondence should be addressed Tel: 00 34 93 428 30 29; Fax: 00 34 93 489 41 09 Email: xvg{at}icf.uab.es
References
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López-Pousa S, Garre Olmo J, Vilalta Franch J, et al. (2006) Comparative analysis of mortality in patients with Alzheimer's disease treated with donepezil and galantamine. Age Ageing 35 365–71.
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