ORIGINAL ARTICLE Effectiveness of switching to the rivastigmine transdermal patch from oral cholinesterase inhibitors: a naturalistic prospective study in Alzheimer’s disease Annachiara Cagnin • Alberto Cester • Bruno Costa • Mario Ermani • Carlo Gabelli • Giuseppe Gambina • SWITCH study working group Received: 13 August 2014 / Accepted: 1 November 2014 Ó Springer-Verlag Italia 2014 Abstract Oral donepezil and rivastigmine are two com- monly used cholinesterase inhibitors (ChEIs) used in Alz- heimer’s disease (AD). The rivastigmine transdermal patch formulation has high tolerability profile, allowing patients to achieve optimal therapeutic doses and providing poten- tial advantages over oral ChEIs. This is a 6-month, multi- centre, observational efficacy and tolerability study of switching from oral ChEIs to rivastigmine patch in AD patients who failed to show benefit from previous treat- ment. The reasons of the switch were: (1) lack/loss of benefit from previous oral ChEI treatment; (2) tolerability problems. The primary outcome was cognitive changes measured with the mini–mental state examination (MMSE) test. Secondary outcomes were modifications of functional independence and behavioral disturbances and occurrence of adverse events (AEs) after switching. 174 patients, over 180 patients screened, entered the study (lack/loss of effi- cacy: 57 %, tolerability problems: 33 %, both reasons: 10 %). 6 months after switching 56 % of patients stabi- lized or increased the MMSE score respect to baseline. The only predictor of this outcome was the response at 3 months. In the group with lack/loss of response to oral ChEI, the decline of the MMSE score changed from -3.4 ± 2.5 points in the 6 months before switching to -0.5 ± 3.2 in the 6 months after the switch (p \ 0.001). There were no significant changes in the IADL or NPI scores. Drug discontinuation rate was 20 %, due to AEs (18 %) and lack of compliance (2 %). Switching from an unsuccessful oral ChEI therapy to rivastigmine patch is effective and safe in more than half of the switched patients after a 6-month period. Keywords Cholinesterase inhibitor drug Á Rivastigmine patch Á Switch among ChEIs Introduction Cholinesterase inhibitors (ChEIs) represent the gold standard of symptomatic treatment for patients with mild- to-moderate Alzheimer’s disease (AD) [1]. Donepezil and rivastigmine are ChEIs belonging to the same drug class, but with different pharmacokinetic and pharmacodynamic profiles. These differences influence individual tolerabil- ity and treatment response to each ChEI and are the reasons why clinicians may consider switching among ChEIs a therapeutic option to improve compliance and efficacy [2–4]. In clinical practice, the management of The all participants to the SWITCH study group are listed in the Appendix. A. Cagnin (&) Á M. Ermani Department of Neurosciences SNPSRR, University of Padova Medical School, Via Giustiniani 5, 35128 Padova, Italy e-mail: annachiara.cagnin@unipd.it A. Cagnin Foundation IRCCS San Camillo Hospital, Venice, Italy A. Cester Department of Geriatric and Rehabilitation Medicine, Dolo Hospital, Dolo, VE, Italy B. Costa Neurology Division, Mater Salutis Hospital, Legnago, VR, Italy C. Gabelli CRIC, Medicine Clinic I, University Hospital of Padova, Padova, Italy G. Gambina Alzheimer’s Center, Neuroscience Department, University Hospital of Verona, Verona, Italy 123 Neurol Sci DOI 10.1007/s10072-014-2002-3