Journal Article

Effect of choline alfoscerate in older adult patients with dementia: an observational study from the claims data of national health insurance

Moon, Young Jin, Lee, Sang Ki, Lee, Hyun-kyoung, Yang, Bo Ram, Jung, Heeyoon, Duong, Khanh Linh, Yun, Hwi-yeol, Chae, Jung-woo

2024

Overview

Background Choline alfoscerate, a cholinergic precursor with limited evidence of efficacy in dementia management, has been used for various cognitive impairments in Korea. Partly due to its insurance coverage, this agent appears to incur significant expense for the insurance system. Thus, we aimed to describe choline alfoscerate prescription patterns and analyze their long-term effects in an older adult cohort with dementia. Methods This observational study used the National Health Insurance Service Senior Cohort Dataset. Choline alfoscerate -naïve patients who were diagnosed with dementia between 2003 and 2014 with at least 12 months of follow-up were selected. Time-dependent Cox regression was employed to estimate the association between drug exposure and the risk of treatment failure events. Results There were 11,463 eligible participants, of whom approximately 73% were female, and 19% had been exposed to choline alfoscerate. According to the main regression survival analysis, the association between longitudinal choline alfoscerate use and the risk of progression events related to treatment failure was unclear. However, a significant decrease of nearly 20% in the risk of all-cause mortality was associated with choline alfoscerate exposure, and a slight reduction in progression regarding treatment failure was observed with CA use only during the early stages of diagnosis. Age, sex, insurance premiums, several comorbidities and concurrent medications were significantly associated with the probability of the events according to the multivariate models. Conclusions Further analyses are needed to confirm the early-stage and long-term effectiveness of choline alfoscerate in specific populations, which will help in considering its reimbursement. Graphical abstract

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Aged patients / Aged, 80 and over / Aging / Alzheimer's disease / Atherosclerosis / Choline / Choline alfoscerate / Claims database / Comorbidity / Cox regression model / Dementia / Dementia - drug therapy / Dementia - epidemiology / Dementia disorders / Demographics / Diagnosis / Disease / Dosage and administration / Drug therapy / Female / Geriatrics/Gerontology / Glycerylphosphorylcholine - therapeutic use / Humans / Insurance, Health / Long-term effects / Male / Medicine / Medicine & Public Health / Metabolic disorders / National health insurance / National Health Programs / Observational studies / Older people / Patient outcomes / Patients / Rehabilitation / Republic of Korea - epidemiology / Sensitivity analysis / Survival analysis / Testing