Patients with mild-to-moderately severe Alzheimer’s disease can now get their treatment transdermally following the UK launch of Novartis’ break-through Exelon (rivastigmine) patch.

The patch, which measures 10cm2 and delivers 9.5mg of rivastigmine, is applied once daily to the patient’s skin, and has been shown to have a similar efficacy to the highest dose Exelon capsules.

The UK launch follows the European go-ahead in September, which was based on results from the international Ideal (Investigation of Transdermal Exelon in Alzheimer’s disease) study of 1,200 patients with mild-to-moderate Alzheimer’s disease. This compared patients on the low-dose patch with those taking the 15mg Exelon oral capsules, and found that the low dose patch was just as effective as the high-dose pills. But, aside from its ease of use, the patch’s real benefit is that it gives patients fewer gastrointestinal side effects than its pill predecessor.

The patch formulation allows for the rivastigmine to be delivered steadily across 24 hours, which cuts down on side effects caused by the inevitable peaks when medication is taken orally. According to Novartis, patients using the patch in clinical studies experienced “substantially lower” incidences of nausea (7.2% versus 23.1%) and vomiting (6.2% vs 17%) than with the highest dose of rivastigmine capsules, which has obvious positive implications for improving treatment compliance.

A spokesperson for Novartis confirmed to PharmaTimes that the cost of therapy using the new patch is also comparable to that of its pill-based counterpart, with Exelon Capsules 6mg twice a day costing £2.79 per day, compared to £2.77 a day for the Exelon Patch.

Caregivers support

Importantly, Novartis pointed out that more than 70% of caregivers preferred the patch as a method of drug delivery, with the most common reasons cited for preferring the patch being its ease of use and that it helped them follow treatment schedules better.

Furthermore, the patch can give visual confirmation that the patient is receiving their medication, another plus for treatment compliance, which, in older patients, is often hampered by factors such as misinterpretation of instructions and forgetfulness.

“The Exelon patch represents a valuable advance in the treatment of Alzheimer’s disease,” said Dr Peter Connelly, Consultant in Old Age Psychiatry, Perth, Scotland. “The formulation offers patients and their carers an effective, well-tolerated and convenient therapy option. I expect a significant proportion of carers will find the patch easier to use compared to the conventional formulation,” he added.

And although she could not comment on the Exelon patch specifically, a spokeswoman for the Alzheimer’s Society explained to PharmaTimes that giving patients with dementia medication orally can often be quite problematic, so transdermal delivery will allow for medication to be given more reliably, at regular intervals and, most importantly, non-invasively. She went on to say that transdermal delivery can help both patients and their carers, and offers lots of advantages over oral therapies.

Exelon patch is the first and only transdermal treatment for mild-to-moderate Alzheimer’s disease, a degenerative brain disorder that affects around 252,000 people in the UK, according to the Alzheimer’s Society.