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Memantin

Klassificering: A

Preparat: Axura, Ebixa, Ebixa®, Marbodin, Memantin Ebb, Memantin Orion, Memantin STADA, Memantine Accord, Memantine LEK, Memantine Mylan, Memantine ratiopharm, Memantine Sandoz, Memantine-Merz, Mentixa, Nemdatine

ATC kod: N06DX01

Substanser: memantin, memantinhydroklorid

Sammanfattning

Studier som visar på kliniskt relevanta skillnader i effekt och säkerhet mellan könen vid memantinbehandling saknas.

Additional information

Swedish patients diagnosed with dementia by a specialist (and not by a general practitioner), are diagnosed with Alzheimer’s disease (AD) in 2/3 of the cases. The prevalence of dementia is higher in women, especially among the oldest patients [1]. The incidence of AD in Europe is significantly higher in women than in men (13.25 vs 7.02  per 1000 person-years); these rates increased with age [2].A review identified 48 RCTs of which two had taken patient’s sex into account when evaluating AD treatment efficacy [3].

Pharmacokinetics and dosing

Following a multiple dose administration of memantine 20 mg twice a day, Cmax and AUC in women were approximately 45% higher than in men. However, there were no differences in Cmax or AUC when adjusting for body weight [4]. In another pharmacokinetic study (34 men, 74 women), men had higher oral clearance (CL/F) [5]. Despite the pharmacokinetic differences of memantine, the clinical studies have shown effect with similar doses in men and women, and no sex differentiation in dosing has been suggested [6].

Effects

A Japanese cohort study including AD patients treated with memantine (11 men, 22 women), reported significant improvement of the Abe’s Behavior and Psychological Symptom of Dementia Score (ABS) at 12 months in women. However, these results are not considered clinically relevant due to the low number of patients [7]. No studies with a clinically relevant sex analysis regarding the effects of memantine have been found.

Adverse effects

No studies with a clinically relevant sex analysis regarding adverse effects of memantine have been found.

Reproductive health issues

Regarding teratogenic aspects, please consult Janusmed Drugs and Birth Defects (in Swedish, Janusmed fosterpåverkan).

Other information

In a review of 14 studies (in all 1820 men, 2942 women) the evidence relating to patient functioning as an outcome measure in the treatment with donepezil, galantamine, rivastigmine or memantine for AD was evaluated and showed that the pooled effect size was not significantly affected by patient's sex [8].

An American retrospective data analysis (1100 men, 1991 women) investigated the relationship between adherence to oral AD therapy (rivastigmine, donepezil, galantamine or memantine) and other variables. Men with AD were approximately 18% more likely to be adherent to index oral AD therapy than women [9].

A German study (4883 men, 8027 women) found that younger men (45-60 years) and patients with private health insurance had a lower risk of discontinuation of AD treatment with memantine, donepezil, galantamine, and rivastigmine [10].

Försäljning på recept

Fler kvinnor än män hämtade ut läkemedel innehållande memantin (ATC-kod N06DX01) på recept i Sverige år 2021, totalt 19 705 kvinnor och 13 950 män. Det motsvarar 3,8 respektive 2,7 personer per tusen invånare. Andelen som hämtat ut läkemedel var högst i åldersgruppen 80 år och äldre hos båda könen. I genomsnitt var läkemedel innehållande memantin 1,1 gånger vanligare hos kvinnor [11].

Uppdaterat: 2022-04-06

Litteratursökningsdatum: 2022-01-21

Referenser

  1. Nationella riktlinjer – Utvärdering 2018 Vård och omsorg vid demenssjukdom 2018 Indikatorer och underlag för bedömningar. Socialstyrelsen [www]. [updated 2018-01-01, cited 2022-01-22]. länk
  2. Niu H, Álvarez-Álvarez I, Guillén-Grima F, Aguinaga-Ontoso I. Prevalence and incidence of Alzheimer's disease in Europe: A meta-analysis. Neurologia. 2017;32(8):523-532. PubMed
  3. Canevelli M, Quarata F, Remiddi F, Lucchini F, Lacorte E, Vanacore N et al. Sex and gender differences in the treatment of Alzheimer's disease: A systematic review of randomized controlled trials. Pharmacol Res. 2017;115:218-223. PubMed
  4. Namenda (memantine). DailyMed [www]. US National Library of Medicine. [updated 2018-12-15, cited 2022-01-21]. länk
  5. Noetzli M, Guidi M, Ebbing K, Eyer S, Wilhelm L, Michon A et al. Population pharmacokinetic study of memantine: effects of clinical and genetic factors. Clin Pharmacokinet. 2013;52:211-23. PubMed
  6. Annweiler C, Herrmann FR, Fantino B, Brugg B, Beauchet O. Effectiveness of the combination of memantine plus vitamin D on cognition in patients with Alzheimer disease: a pre-post pilot study. Cogn Behav Neurol. 2012;25:121-7. PubMed
  7. Matsuzono K, Yamashita T, Ohta Y, Hishikawa N, Sato K, Kono S et al. Clinical Benefits for Older Alzheimer's Disease Patients: Okayama Late Dementia Study (OLDS). J Alzheimers Dis. 2015;46(3):687-93. PubMed
  8. Hansen RA, Gartlehner G, Lohr KN, Kaufer DI. Functional outcomes of drug treatment in Alzheimer's disease: A systematic review and meta-analysis. Drugs Aging. 2007;24:155-67. PubMed
  9. Borah B, Sacco P, Zarotsky V. Predictors of adherence among Alzheimer's disease patients receiving oral therapy. Curr Med Res Opin. 2010;26:1957-65. PubMed
  10. Bohlken J, Weber S, Rapp MA, Kostev K. Continuous treatment with antidementia drugs in Germany 2003-2013: a retrospective database analysis. Int Psychogeriatr. 2015;27(8):1335-42. PubMed
  11. Statistikdatabas för läkemedel. Stockholm: Socialstyrelsen. 2021 [cited 2022-03-15.] länk

Författare: Pauline Raaschou, Linnéa Karlsson Lind

Faktagranskat av: Diana Rydberg

Godkänt av: Karin Schenck-Gustafsson