Abstract
Importance
Age-related macular degeneration (AMD) is the leading cause of blindness in people aged 50 years and above worldwide. There is a need for new strategies for the prevention and treatment of AMD. There is some limited evidence to suggest the possibility of a protective effect of dementia medications on the development of some types of AMD, but the evidence is weak.
Objective
To investigate whether dementia medications Memantine and Donepezil are associated with risk of subsequent development of AMD.
Design
We performed three population-based cohort studies.
Setting
We used data from the Clinical Practice Research Datalink (CPRD) GOLD and Aurum databases (2002-2022). The analysis was carried out between February and November 2023.
Participants
Participants included individuals with dementia (vascular dementia, non-vascular dementia, or Alzheimer’s) aged 40 years and above.
Exposure
Exposures were dementia medications. Cohort One compared patients prescribed Donepezil with those prescribed Rivastigmine/Galantamine using the new-user design. Cohort Two compared Memantine with Donepezil/Rivastigmine/Galantamine using the prevalent-new user design; and in a sensitivity analysis, Cohort Three compared Memantine with Rivastigmine/Galantamine only.
Outcomes
Outcome was new diagnosis of AMD.
Results
There were 132,846, 159,419 and 92,328 individuals with a diagnosis of dementia included in Cohorts One, Two and Three, respectively; mean age was 80 years, 62% were female, and mean BMI was 25 kg/m2. The adjusted hazard ratio (HR) for Donepezil compared to Rivastigmine/Galantamine (Cohort One) was 0.95 (95% CI 0.67, 1.35). The adjusted HR for Memantine compared to Donepezil/Rivastigmine/Galantamine (Cohort Two) was 1.03 (95% CI 0.83 to 1.27). The adjusted HR for Memantine versus Rivastigmine/Galantamine only was 1.24 (95% CI 0.83 to 1.86).
Conclusion
In this cohort study of patients with dementia, we found no significant associations between Memantine or Donepezil compared to other dementia medications and the risk of development of AMD.
Age-related macular degeneration (AMD) is the leading cause of blindness in people aged 50 years and above worldwide. There is a need for new strategies for the prevention and treatment of AMD. There is some limited evidence to suggest the possibility of a protective effect of dementia medications on the development of some types of AMD, but the evidence is weak.
Objective
To investigate whether dementia medications Memantine and Donepezil are associated with risk of subsequent development of AMD.
Design
We performed three population-based cohort studies.
Setting
We used data from the Clinical Practice Research Datalink (CPRD) GOLD and Aurum databases (2002-2022). The analysis was carried out between February and November 2023.
Participants
Participants included individuals with dementia (vascular dementia, non-vascular dementia, or Alzheimer’s) aged 40 years and above.
Exposure
Exposures were dementia medications. Cohort One compared patients prescribed Donepezil with those prescribed Rivastigmine/Galantamine using the new-user design. Cohort Two compared Memantine with Donepezil/Rivastigmine/Galantamine using the prevalent-new user design; and in a sensitivity analysis, Cohort Three compared Memantine with Rivastigmine/Galantamine only.
Outcomes
Outcome was new diagnosis of AMD.
Results
There were 132,846, 159,419 and 92,328 individuals with a diagnosis of dementia included in Cohorts One, Two and Three, respectively; mean age was 80 years, 62% were female, and mean BMI was 25 kg/m2. The adjusted hazard ratio (HR) for Donepezil compared to Rivastigmine/Galantamine (Cohort One) was 0.95 (95% CI 0.67, 1.35). The adjusted HR for Memantine compared to Donepezil/Rivastigmine/Galantamine (Cohort Two) was 1.03 (95% CI 0.83 to 1.27). The adjusted HR for Memantine versus Rivastigmine/Galantamine only was 1.24 (95% CI 0.83 to 1.86).
Conclusion
In this cohort study of patients with dementia, we found no significant associations between Memantine or Donepezil compared to other dementia medications and the risk of development of AMD.
| Original language | English |
|---|---|
| Journal | JAMA network open |
| Publication status | Accepted/In press - 23 Aug 2024 |
Bibliographical note
Not yet published as of 02/09/2024Keywords
- dementia
- age-related macular degeneration
- Cohort study
- memantine
- donepezil
- rivastigmine
- galantamine