Effect of butyrylcholinesterase genotype on the response to rivastigmine or donepezil in younger patients with Alzheimer's disease.

Full Abstract

A randomized double-blind trial evaluated the efficacy and tolerability of rivastigmine, an inhibitor of acetylcholinesterase (AChE) and butyrylcholinesterase (BuChE), and donepezil, an AChE-selective inhibitor, in patients with Alzheimer's disease over a 2-year period. A retrospective analysis showed differential responses to cholinesterase inhibitors (ChE-Is) in patients younger than 75 years. This analysis investigated the effect of BuChE genotype on response to ChE-I therapy in these patients. In a retrospective analysis, patients younger than 75 who had consented to pharmacogenetic analysis were divided into groups according to BuChE genotype. Efficacy measures were the Severe Impairment Battery (SIB), Neuropsychiatric Inventory (NPI), Global Deterioration Scale (GDS), Mini-Mental State Examination (MMSE) and the Alzheimer's Disease Cooperative Study-Activities of Daily Living Scale (ADCS-ADL). Changes on efficacy parameters were calculated for rivastigmine-treated and donepezil-treated patients in both groups. Of 114 (34.1%) patients younger than 75 who were successfully assessed for BuChE genotype, 76 (66.7%) were homozygous for wild-type BuChE, and 38 (33.3%) carried at least one BuChE K-variant allele. Wild-type BuChE carriers showed significantly greater responses to rivastigmine than to donepezil on the SIB, ADCS-ADL, GDS and NPI. No significant between-treatment differences in efficacy were observed in BuChE K-variant carriers, although adverse events were more frequent in rivastigmine-treated patients. In this retrospective analysis, Alzheimer's disease patients younger than 75 with wild-type BuChE exhibited differential efficacy to rivastigmine, while BuChE K-variant carriers experienced similar long-term treatment effects with both agents. These differences may reflect rivastigmine's ability to inhibit BuChE and AChE.

Author information

Author/s: Blesa, Rafael (R); Bullock, Roger (R); He, Yunsheng (Y); Bergman, Howard (H); Gambina, Giuseppe (G); Meyer, Joanne (J); Rapatz, Günter (G); Nagel, Jennifer (J); Lane, Roger (R);

Affiliation: Hospital Sta Creu i Sant Pau, Barcelona, Spain. rblesa(-atsign-)hsp.santpau.es

Journal and publication information

Publication Type: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

Journal: Pharmacogenetics and genomics (Pharmacogenet Genomics), published in United States. (Language: eng)

Reference: 2006-Nov; vol 16 (issue 11) : pp 771-4

Dates: Created 2006/10/18; Completed 2007/02/06; Revised 2008/11/21;

PMID: 17047484, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Aged
Alzheimer Disease - drug therapy; enzymology
Butyrylcholinesterase - genetics
Cholinesterase Inhibitors - adverse effects; therapeutic use
Female
Genetic Variation
Genotype
Heterozygote

Humans
Indans - adverse effects; therapeutic use
Male
Middle Aged
Phenylcarbamates - adverse effects; therapeutic use
Piperidines - adverse effects; therapeutic use
Retrospective Studies
Treatment Outcome

Associated Chemicals: Cholinesterase Inhibitors (0) ; Indans (0) ; Phenylcarbamates (0) ; Piperidines (0) ; donepezil (120011-70-3) ; rivastigmine (123441-03-2) ; Butyrylcholinesterase (EC 3.1.1.-)

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