Dextromethorphan/Quinidine Mix Quells Alzheimer’s Anxiety, Aggression
Key clinical point: The combination of dextromethorphan and quinidine helped to control agitation and aggression in Alzheimer’s patients.
Major finding: Over 10 weeks, those taking the combination of dextromethorphan and quinidine showed a 4.5-point improvement on the NPI aggression subscale, compared with a 1.5-point improvement in the placebo group.
Data source: A randomized, double-blind, placebo-controlled study of 220 patients.
Disclosures: Dr. Pioro is a consultant for Avanir Pharmaceuticals, which manufactures Nuedexta.
AT CTAD
By the end of the first 5-week phase, patients in the active group experienced a mean improvement of 3.3 points on the NPI aggression subscale, which was significantly better than the 1.7-point improvement seen among those taking placebo.
After the placebo nonresponders had been rerandomized and treated for another 5 weeks, those taking the study drug had a mean 2-point improvement, compared with a 0.8-point improvement among those taking placebo.
In the group that been on their originally assigned treatment for the entire 10 weeks, those taking the study drug again fared significantly better (a mean improvement of about 4.5 points vs. 1.5 points with placebo).
In all randomization schemes, the clinical and physicians’ global impression improved significantly more in the active group than in the placebo group.
The total NPI score improved significantly more in the active group (13.5 vs. 8.5 points for those who had been on the same treatments for 10 weeks). NPI symptom clusters showed the same pattern of improvement favoring the study drug.
Measurements of caregiver response based on the Caregivers Strain Index and the NPI Caregiver Distress Score both significantly improved more for caregivers of patients taking the study drug for 10 weeks, compared to those taking placebo.
Treatment-emergent adverse events were significantly more common among the patients who took the study drug (61% vs. 43%). The most common were falls (9% vs. 4%), diarrhea (6% vs. 3%), urinary tract infection (5% vs. 4%), and dizziness (5% vs. 2.5%). These caused 5% of patients taking the drug and 3% taking placebo to discontinue treatment.
Dr. Pioro is a consultant for Avanir, which manufactures Nuedexta.
