Neurology Practice Changers: 2013
Neurology Practice Changers: 2013
A higher-dose rivastigmine patch (13.3 mg/24 hr) (Exelon®) received FDA approval this year for the treatment of severe Alzheimer disease. Rivastigmine is an acetylcholinesterase inhibitor already approved for patients with mild to moderate dementia of Alzheimer disease, as well as mild to moderate dementia associated with PD, at a minimally effective dose of 9.5 mg/24 hr.
The new higher-dose 13.3 mg/24 hr patch demonstrated significantly less cognitive deterioration at weeks 16 and 24 as measured with the Severe Impairment Battery and function as measured by the AD Cooperative Study-Activities of Daily Living scale-Severe Impairment Version, compared with 4.6 mg/24 hr in the ACTION randomized, double-blind, 24-week trial. As might be expected, adverse reactions, such as application site erythema, falls, insomnia, nausea, vomiting, and diarrhea occurred in a higher percentage of patients in the 13.3 mg/24 hr group. Given that patients with severe Alzheimer dementia may not cooperate with swallowing pills, the higher-dose patch may prove a more practical approach to maximizing function in this difficult-to-treat population.
The FDA has approved a novel, high-tech sumatriptan iontophoretic transdermal patch for patients with acute migraine with or without aura. Marketed as Zecuity® by the pharmaceutical company NuPathe, the device measures 4 × 8 inches, wraps around the arm or thigh, and includes a battery-powered computer chip to deliver medication over 4 hours through the skin. Zecuity is the first transdermal patch for the treatment of migraine.
Sumatriptan, a 5-hydroxytryptamine agonist, is widely used as an abortive medication for migraine and is already available as an oral tablet, injection, and nasal spray. Zecuity offers another route for acute administration that may be preferred by patients, particularly the approximately 50% of patients with migraine-associated nausea that discourages oral administration as well as those with an aversion to needles. On the other hand, some patients who participated in the clinical trial did not like the skin reddening or pain that can occur at the application site.
Refining Alzheimer Disease Therapy, and a 21st-Century Migraine Patch
A higher-dose rivastigmine patch (13.3 mg/24 hr) (Exelon®) received FDA approval this year for the treatment of severe Alzheimer disease. Rivastigmine is an acetylcholinesterase inhibitor already approved for patients with mild to moderate dementia of Alzheimer disease, as well as mild to moderate dementia associated with PD, at a minimally effective dose of 9.5 mg/24 hr.
The new higher-dose 13.3 mg/24 hr patch demonstrated significantly less cognitive deterioration at weeks 16 and 24 as measured with the Severe Impairment Battery and function as measured by the AD Cooperative Study-Activities of Daily Living scale-Severe Impairment Version, compared with 4.6 mg/24 hr in the ACTION randomized, double-blind, 24-week trial. As might be expected, adverse reactions, such as application site erythema, falls, insomnia, nausea, vomiting, and diarrhea occurred in a higher percentage of patients in the 13.3 mg/24 hr group. Given that patients with severe Alzheimer dementia may not cooperate with swallowing pills, the higher-dose patch may prove a more practical approach to maximizing function in this difficult-to-treat population.
A New Patch for Migraine
The FDA has approved a novel, high-tech sumatriptan iontophoretic transdermal patch for patients with acute migraine with or without aura. Marketed as Zecuity® by the pharmaceutical company NuPathe, the device measures 4 × 8 inches, wraps around the arm or thigh, and includes a battery-powered computer chip to deliver medication over 4 hours through the skin. Zecuity is the first transdermal patch for the treatment of migraine.
Sumatriptan, a 5-hydroxytryptamine agonist, is widely used as an abortive medication for migraine and is already available as an oral tablet, injection, and nasal spray. Zecuity offers another route for acute administration that may be preferred by patients, particularly the approximately 50% of patients with migraine-associated nausea that discourages oral administration as well as those with an aversion to needles. On the other hand, some patients who participated in the clinical trial did not like the skin reddening or pain that can occur at the application site.
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