Posts Tagged ‘Alzheimers’

Exelon Follow-Up

11/01/2007 , 11:36 AM by Alex Sicre

October 23rd 2007 was the first day that the Exelon transdermal patch, the first and only skin patch for the symptomatic treatment of mild to moderately severe Alzheimer’s dementia, is available in the UK market. Here’s some info on it from ITNews.com, no author given:

A clinical study of 1,195 people with Alzheimer’s dementia demonstrated that the rivastigmine patch improves cognitive function (assessed using a tool that includes measures of orientation, memory and language), as well as a patient’s ability to perform everyday activities compared to placebo. The study also showed that the 9.5mg/24h patch is as effective as the maximum titrated dose of rivastigmine oral capsules.

Applied once a day (replaced every 24 hours), the rivastigmine patch provides smooth and continuous delivery of rivastigmine through the skin, which reduces nausea and vomiting caused by peaks in medication levels when the drug is taken orally.
Dr Peter Connelly, Consultant in Old Age Psychiatry, Perth, Scotland comments, “The Exelon patch represents a valuable advance in the treatment of Alzheimer’s disease. This formulation offers patients and their carers an effective, well-tolerated and convenient therapy option. I expect a significant proportion of carers will find the patch easier to use compared to the conventional formulation.”

Family cargivers are the backbone of long-term care to Alzheimer’s disease patients, frequently responsible for administering and managing patient medication. A survey conducted in over 1,000 caregivers showed that more than 70 per cent preferred the patch as a method of drug delivery compared to oral capsules(3). The most common reasons for preferring the patch were ease of following the schedule and ease of use.

The rivastigmine patch can be applied to the upper arm, chest or back(4). The patch may allow those caring for Alzheimer’s disease patients to monitor treatment compliance because it provides visual reassurance that the medication has been taken. Compliance with prescribed medication regimens represents a challenge for most patients but may be particularly difficult for older people due to: the extent to which drug regimens interfere with daily living; lack of understanding or misinterpretation of instructions; complex and complicated drug regimens; and forgetfulness(6). 75% of older people are believed to not comply with their treatment regimens.

“Caring for a relative with Alzheimer’s is very time-consuming and sometimes overwhelming. There’s a lot to think about and sufferers are often on a number of medications,” comments carer Lisa, who used to look after her sister at home. “People with the disease can find it difficult to take oral medication and to comply with a strict routine. A patch that provides 24 hour cover could help keep track of when medication has been taken.”

COMMENTS
I’m all for anything to improve patient medication adherence. Once again my hope is that patients remember they have the patch on and rmember to change them as well. To celebrate National Caregivers Month – here’s to Novartis!

EU Approval for Exelon

09/20/2007 , 10:44 AM by Alex Sicre

I have writen about patches in the past – both pro and con. With the EU approval of Exelon, caregivers and patients with Alzheimer’s have reason to cheer for better medication adherence. I can only imagine how difficult it must be to care for a parent or spouse with Alzheimer’s – not to mention their medication regime. Hopefully the Exelon patch will have a successful launch and adoption in the EU.

The Exelon patch was approved in the US in July and some expect sales to reach the $1B mark.

Here is a blurb from 9/24 Nursing In Practice website, no author provided:

The European Commission has on today approved the use of a transdermal patch to deliver medicine to patients with mild-to-moderately severe Alzheimer’s disease. The patch is the first type of transdermal treatment for Alzheimer’s disease and is applied once a day to the back, chest or upper arm of patients.

Experts say the patch improves compliance for Alzheimer’s patients and also reduces side-effects.

“All these benefits offer the potential for improved outcomes in patients,” said James Shannon, global head of development at Novartis Pharma.

“Exelon patch represents a therapeutic innovation that is designed specifically to meet the needs of patients, caregivers and physicians involved with this devastating disease.”

Bruno Dubois, Professor of Neurology in Paris, France, agrees that the patch provides vital reassurance that patients have “taken” their medicine, adding: “Just having to apply a patch can help reduce the burden of family life for people with Alzheimer’s disease and their families.”

In a survey of Alzheimer’s caregivers, 70% said they preferred the patch to oral medicines as it helped them follow their treatment schedules and was easier to use.

“People with Alzheimer’s disease and their caregivers welcome every new therapy for the disease,” said Mark Wortmann, executive director of Alzheimer’s Disease International. “I am pleased that the patch offers a new approach to treatment.”

Problems with Skin Patches

08/13/2007 , 10:36 AM by Alex Sicre

I have always been a big fan of medication patches from the begining for medication adherence. I remember first seeing “the patch” for smoking sensation and am glad that they are able to adapt this technology for Alzheimer’s and Parkinson’s. Although I do remember my father smoking and chewing Nicorette while using the patch, and getting incredibly sick.

I had heard about problems with the contraceptive patch, but had never heard of a narcotic patch. I can see how these problems can occur, especially for older patients who put a patch on Monday, then forget on Wednesday and put another one on. Although I would think they would solve this problem with packaging.

And discarded patches seem to be a problem as well. Here’s an article I found from the Toronto Star from 8/7/07. It only discusses Canadian problems, but I’m sure they are applicable in the US.

Skin Patches Have Their Downside by Nancy J. White.

Morag Dickie liked the convenience. She could just slap the nitroglycerin patch onto her body in the morning and not worry about popping pills.

“I could feel a consistent flow of energy,” says Toronto resident Dickie, 55, a heart patient.

That’s the idea behind a skin patch – an easy-to-use method with smooth, controlled drug release, not the peaks and valleys of ingested medicine. In the U.S. last month, the Food and Drug Administration approved the first skin patch to treat Alzheimer’s disease. In May, it gave the green light to a drug patch for Parkinson’s disease. Last year, medicinal patches were approved Attention Deficit Hyperactivity Disorder and depression.

Researchers are developing an insulin patch for diabetics.

But it’s also a system that can present problems from the occasional skin irritation – the reason Dickie, who has sensitive skin, had to eventually give up her patch – to unintended poisonings. Three people in this country have died from use of the narcotic fentanyl patch, according to the Institute for Safe Medication Practices Canada (ISMPC).

In June, a federal jury in the U.S. awarded $5.5 million to the father of a 28-year-old man who died in 2003 while wearing a fentanyl patch for chronic hip pain after a car accident.

In Canada, prescription patches are approved for a handful of uses, including contraception and hormone replacement therapy, pain relief, smoking cessation, prevention of motion sickness and control of angina.

As for new ones, Health Canada does not disclose drugs it is reviewing, according to a spokesman. The patch to treat the dementia of Alzheimer’s has been submitted to Health Canada and the manufacturer hopes for approval next year, says Jason Jacobs, a spokesman for Novartis Pharmaceuticals Canada. That patch delivers the drug Exelon or rivastigmine, which is currently sold in Canada for oral use.

Patches provide a smoother delivery of drugs than tablets, which send medication for absorption to the intestine, and may lessen the potential for side effects by avoiding a high peak.

They are longer-acting, some up to a week. “There’s better compliance when the patient doesn’t have to worry about taking a medicine three or four times a day,” says Bill Wilson, pharmacy director at Mount Sinai Hospital.

Patients may, however, forget they’re wearing a patch, especially since some are clear. “We’ve had reports of more than one patch of the same drug put on a person,” says Sylvia Hyland, vice president of the non-profit group ISMPC.

Youngsters have been poisoned by chewing ondiscarded patches or putting them on. “Children are fascinated by stickers and bandages,” says Hyland. “A thrown-away patch still has some drug in it.”

The ISMP has had reports from emergency room staff concerned by unlabelled patches. And the most dangerous are the patches delivering fentanyl, a narcotic. “They need to be prescribed appropriately for chronic severe pain, not acute pain,” explains Hyland. “Physicians need to be very knowledgeable about the patch.”

Two of the Canadian deaths from the fentanyl patch were adolescents. The deaths occurred in 2004. It’s supposed to be only for adults, says Hyland.

The birth-control patch, EVRA, has also raised concerns after a study indicated women using it in the U.S. had an increased risk of blood clots in the legs and lungs than women on an oral contraceptive. Another study, however, showed no difference in the risk.