Weight Loss Associated with Cholinesterase Inhibitors in Individuals with Dementia in a National Healthcare System

ObjectivesTo determine whether initiation of cholinesterase inhibitors is associated with significant weight loss in a real-word clinical setting. DesignRetrospective cohort study from 2007 to 2010 comparing weight loss in individuals with dementia newly prescribed cholinesterase inhibitors and those newly prescribed other chronic medications. SettingNational Veterans Affairs data. ParticipantsIndividuals aged 65 and older with a diagnosis of dementia who received a new prescription for a cholinesterase inhibitor or other new chronic medication. MeasurementsThe primary outcome was time to 10-pound weight loss over 12months. Propensity score matching was used to control for the likelihood of receiving a cholinesterase inhibitor based on baseline characteristics. Data were analyzed in a priori defined subgroups according to age, comorbid burden, and initial weight. ResultsOf 6,504 individuals that met study criteria, 1,188 started on cholinesterase inhibitors were matched to 2,189 started on other medications. The propensity-matched cohorts were well balanced on baseline covariates. Participants initiated on cholinesterase inhibitors had a higher risk of weight loss than matched controls at 12months (hazard ratio=1.23, 95% confidence interval (CI) =1.07-1.41). At 12months, 29.3% of participants taking cholinesterase inhibitors had experienced weight loss, compared with 22.8% of nonusers, corresponding to a number needed to harm of 21.2 (95% CI=12.5-71.4) over 1year. There were no significant differences in the risk of weight loss within subgroups. ConclusionThese results are consistent with the available data from randomized controlled trials. Clinicians should consider the risk of weight loss when prescribing cholinesterase inhibitors.