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No difference between pharmacologic treatments in age-related macular degeneration risk reduction
1. In this retrospective cohort of individuals with dementia, there was no statistically
significant difference between donepezil or memantine compared to other
pharmacologic treatments for dementia, and the risk of age-related macular
degeneration (AMD) development.
2. In all of the groups, there was a low percentage of participants that developed AMD,
ranging from 0.6% in cohort 2 to 1.1% in cohort 1.
Evidence Rating Level: 2 (Good)
Study Rundown: The world is faced with a growing population, partly due to the increased life
expectancy of many countries. As a result, finding treatments for diseases associated with aging
is significant in treating a large proportion of the population. Age-related macular degeneration
(AMD) is the primary cause of blindness in people aged 50 years and older and may be
associated with dementia. Due to their similar pathophysiology patterns, it has been
hypothesized that treatments for dementia could be effective for AMD, however, this has not
been extensively tested. Therefore, this study had the goal of assessing if there is an association
between donepezil or memantine (compared to other dementia medication) with a reduced
risk of AMD development in patients with dementia. Three separate cohort studies were
conducted to determine the aforementioned association. After adjusting for confounding in
each of the cohorts, there was no statistically significant difference between any of the
dementia medications (donepezil vs other first-line drugs or memantine vs first-line drugs).
These results indicate that there is no difference among the drugs in patient safety. Although
the study was conducted using a diverse population, the findings may not be generalizable to
countries not in the United Kingdom with different healthcare systems. Additionally, if all the
drugs used in the study had the same protective effect on dementia development this could
have masked any protective association of donepezil or memantine. Overall, due to the several
limitations, further research on this topic has been recommended.
Click here to read the study in JAMA Network Open
In-Depth [retrospective cohort]: This retrospective cohort study was conducted to determine if
there were significant differences in pharmacologic medications for individuals with dementia,
and their risk of developing AMD. Participants were deemed eligible for the study if they were
aged 40 years or older and had a preexisting diagnosis of dementia that had been treated
pharmacologically. If participants had a previous history of AMD or developed it within the first
three months after their dementia diagnosis, they were excluded. Cohort 1 compared
participants with a donepezil prescription to those prescribed rivastigmine or galantamine
while cohort 2 compared those prescribed memantine to those with any first-line medication,
and cohort 3 compared participants with a memantine prescription to those with a rivastigmine
or galantamine prescription. A total of 132,846 individuals with a dementia diagnosis were
included in cohort 1 (mean [SD] age, 80.4 (7.6) years; 61% female, mean [SD] BMI, 25.5 (4.6)),
159,419 participants in cohort 2 (mean [SD] age, 81.2 (7.6) years; 59.7% female, mean [SD] BMI,
25.6 (4.7)), and 92,328 participants in cohort 3 (mean [SD] age, 80.9 (7.7) years; 58.5% female,
mean [SD] BMI, 25.5 (4.7)). After adjustments, cohort 1 had an adjusted HR of 0.95 (95% CI
0.67-1.35), while cohort 2 had an adjusted HR of 1.03 (95% CI, 0.83-1.27), and cohort 3 had an
adjusted HR of 1.24 (95% CI, 0.83-1.86). Overall, there was no significant difference between
the dementia medications in the reduction of AMD development.
Image: PD
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