Exelon (rivastigmine) depot patch is a new formulation of the acetylcholinesterase inhibitor ricastigmine in treatment of Alzheimers disease. The patch is administered once daily.
A single randomised double-blinded double-dummy study shows that 17,5 % of patients using the patch reached a predefined clinical endpoint at ≥ 4 points improvement on ADAS-Cog and no impairment on the ADCS – CGIC scale. Respectively 18,8 % and 10,3 % of patients using rivatigmine capsules or placebo reached the clinical endpoint. There was a significant difference between the effect of the patch and placebo, but not between the patch and the capsules.
There was statisticly significant a lesser number of side effects in the use of the patch (51 %) than in the use of capsules (63 %). The primaryly experienced side effects were gastrointestinal. Rivastigmine depot patch has not been compared with other acetylcholinesterase inhibitors or NMDA antagonists. The effect of rivastigmine capsules has been compared with capsules containing donepezile (Aricept). The drugs have similar effect, but the patients in the donepezile group experienced fewer side effects.
A randomised double-blinded double-dummy placebo and active controlled study (n = 1.059) describes the care givers preferences in the use of the patch. There was statistic significantly more care givers that preferred the patch (70 %) compared to the capsules (30 %). It is unknown whether this endorses better patient compliance.
A daily treatment with rivastigmine depot patch, maximal dose 9,5 mg/24 hours costs 40,86 Dkr, while it for rivastigmin 6 mg capsules is 40,56 Dkr. A daily treatment with 10 mg of donepezile (Aricept) or 24 mg galantamine (Reminyl) costs respectively 29,75 Dkr and 38,64 Dkr.
IRF states that you can start a new treatment of dementia with donepezil (Aricept) in case that the criteria’s for medical dementia is fulfilled. The argument for starting treatment with donepezil is that there were no apparent difference in the effects of donepezile and ricastigmine and that Exelon depot patch has relatively high price. Patients that already tried treatment with rivastigmine capsules and experience a satisfactory effect can with advantage change to the patch if there are not any adverse effects. The patients that have problems in taking oral formulations can with advantage us the rivastigmine depot patch.
Exelon depot patch was marketed the 3rd of December 2007. Exelon depot patch is in dispensing group A. Exelon is not covered under the rules of general reimbursement.