Patterns and predictors of cholinesterase inhibitor use in dementia with Lewy bodies.

Introduction: Current evidence supports the use of cholinesterase inhibitors (ChEIs) as the first-line symptomatic treatment for improving cognition in dementia with Lewy bodies (DLB). Little is known about current prescribing patterns of ChEIs in DLB. This study aimed to identify the patterns and predictors of ChEI prescribing in patients with DLB in the United States.

Methods: Using the TriNetX database, we identified 20,643 US patients ages 45 to 90 who were diagnosed with DLB between 2004 and 2024. We only included those with more than one documented diagnosis. Prescription data and patterns for donepezil, rivastigmine, galantamine, and memantine were analyzed. We used multivariate logistic regression models to estimate the odds of ChEI prescription based on demographic factors.

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 (odds ratio [OR] 1.36, 95% confidence interval [CI]: 1.15, 1.59) and reside in the Midwest (OR 1.93, 95% CI: 1.76, 2.13), while Black patients were less likely to be prescribed ChEIs (OR 0.80, 95% CI: 0.71, 0.91). Of patients prescribed ChEIs, the median time between the first and last prescription was 13.4 months (interquartile range: 1.1, 32.9), and donepezil was the most commonly prescribed (76.9%) followed by rivastigmine (35.6%) and galantamine (3.9%). 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 evidence supporting their tolerability and efficacy, ChEIs are under-prescribed in DLB patients within the United States, 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 use can be developed.

Highlights: Despite proven tolerability and efficacy, cholinesterase inhibitors (ChEIs) are under-prescribed in dementia with Lewy bodies (DLB).Race, ethnicity, and region significantly affected the odds of ChEI prescription.There is a need to increase ChEI prescribing for DLB patients.