Treatment patterns of symptomatic treatments for Alzheimer’s disease and related dementias

Limited real-world evidence exists on the patterns of symptomatic treatment use for Alzheimer’s disease and related dementias (ADRD). Using data from the Merative® MarketScan Research Databases, we analyzed treatment patterns in ADRD patients aged ≥ 65 from 2011 to 2021. Initial treatment choices, subsequent changes, and factors influencing these changes were evaluated over an 18-month period. Among 74,212 acetylcholinesterase inhibitor (AChEI) and 15,917 memantine initiators, 56% switched or discontinued their initial treatment within 6 months. By 18 months, 15% of monotherapy initiators remained on initial treatment and 19% escalated to dual therapy, with 13% of AChEI initiators switching to memantine. After discontinuation, 73% reinitiated treatment within 18 months. Patients with milder dementia severity, fewer comorbidities, and lower frailty levels were more likely to switch to alternative treatments. Patients with ADRD demonstrated low persistence with their initial symptomatic therapy, coupled with high rates of re-initiation following discontinuation.