Objective: The objective of this study was to identify the patterns and predictors of cholinesterase inhibitor (ChEI) prescribing in Dementia with Lewy bodies (DLB) patients.

Background: Current evidence supports the use of ChEIs, i.e., donepezil, rivastigmine, and galantamine, as the first-line symptomatic treatment for improving cognitive and behavioral symptoms of DLB, but little is known about current prescribing patterns of ChEIs in DLB.

Method: Using the TriNetX database, we identified 20,643 US patients ages 45-90 who were diagnosed with DLB between 2004 and 2024. We only included those with more than one documented diagnosis. Prescription data for donepezil, rivastigmine, galantamine, and memantine were extracted using RxNorm and National Drug Codes codes. We used multivariate logistic regression models to estimate the odds of cholinesterase inhibitor prescription based on demographic factors. We also examined prescribing patterns for the 3 ChEIs across the 20-year period.

Results: We found that 51.9% of DLB patients were ever prescribed a ChEI, and those who were prescribed a ChEI had a greater diagnosis interval. Patients who were prescribed ChEIs were more likely to be Hispanic (OR 1.36, 95% CI: 1.15, 1.59) and reside in the Midwest (OR 1.93, 95% CI: 1.76, 2.13) or West (OR 1.37, 95% CI: 1.23, 1.52), while Black or African American patients were less likely to be prescribed ChEIs (OR 0.80, 95% CI: 0.71, 0.91). Of those DLB patients prescribed ChEIs, 54.9% of patients were prescribed a ChEI prior to their first DLB diagnosis, the median prescription interval was 14 months (IQR: 4.7, 30.6), and most (84.3%) were only prescribed one ChEI. Donepezil was the most prescribed ChEI (76.9%) followed by rivastigmine (35.6%) and galantamine (3.9%). A total of 20.3% of DLB patients were prescribed memantine, and DLB patients were more likely to be prescribed memantine if they were also prescribed a ChEI (32.3% vs. 7.1%). Over the 20-year study period, there was a gradual increase in the rate of prescribing of ChEIs, and the prescribing frequency of individual ChEIs remained relatively stable.

Conclusion: Despite proven tolerability and efficacy, ChEIs are under-prescribed in DLB patients within the US, and there are differences in prescribing based on race, ethnicity, and region. There is a need to understand the reasons for under-prescribing ChEIs in DLB, so interventions focused on increasing utilization can be developed.

References: None.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/patterns-and-predictors-of-cholinesterase-inhibitor-use-in-dementia-with-lewy-bodies/