Clinical Recommendations for the Use of Donepezil 23 mg in Moderate-to-Severe Alzheimer's Disease in the Asia-Pacific Region

• Main Authors: Marwan Sabbagh, SeolHeui Han, SangYun Kim, Hae-Ri Na, Jae-Hong Lee, Nagaendran Kandiah, Kammant Phanthumchinda, Chuthamanee Suthisisang, Vorapun Senanarong, Ming-Chyi Pai, Diatri Narilastri, Ajit M. Sowani, Encarnita Ampil, Amitabh Dash
• Format: Article
• Language: English
• Published: Karger Publishers 2016-09-01
• Series: Dementia and Geriatric Cognitive Disorders Extra
• Subjects: Donepezil; Alzheimer’s disease; Acetylcholinesterase inhibitors; Dementia; Aging; Disease progression; Dose-response relationship
• Online Access: http://www.karger.com/Article/FullText/448214

Background: The ‘Asia-Pacific Expert Panel (APEX) for donepezil 23 mg' met in November 2015 to review evidence for the recently approved high dose of donepezil and to provide recommendations to help physicians in Asia make informed clinical decisions about using donepezil 23 mg in patients with moderate-to-severe Alzheimer's disease (AD). Summary: In a global phase III study (study 326) in patients with moderate-to-severe AD, donepezil 23 mg/day demonstrated significantly greater cognitive benefits versus donepezil 10 mg/day, with a between-treatment difference in mean change in the Severe Impairment Battery score of 2.2 points (p Key Message: Donepezil 23 mg is a valuable treatment for patients with AD, particularly those with advanced disease. The APEX emphasized the importance of patient selection (AD severity, tolerability of lower doses of donepezil, and absence of contraindications), a stepwise titration strategy for dose escalation, and appropriate monitoring and counseling of patients and caregivers in the management of patients with AD.