Feb 23, 2026
3 min read
The French team recommends reconsidering the delisting of anticholinesterase drugs for Alzheimer's disease.Their study showed modest but persistent cognitive benefits from this class of drugs and adverse effects from discontinuation.“Withdrawal of anticholinesterase drugs strongly initiates cognitive decline without improving survival,” the authors say.
The French team recommends reconsidering the elimination of anti-cholinesterase drugs for Alzheimer's disease.Their study shows modest but lasting cognitive benefits of this type of drug.and the dangerous effects of stopping those medicationsThe authors said, "Stopping anticholinesterase medicationIt will accelerate severe cognitive decline with no benefit to survival.”
After receiving marketing authorization in the early 2000s, anticholinesterase drugs - donepezil, galantamine and rivastigmine - were reimbursed for the treatment of mild to moderate forms of Alzheimer's disease. According to the Transparency Commission (CT) in 2007, their safety profile was "generally good" and "similar for cognitive and non-cognitive symptoms", but in May 2018 they were delisted.Recorded in 2016. Closed in 2016 after re-evaluation of actual benefit.
Rapid decline from the first month after stopping
In this work, the authors used databases from the National Bank for Alzheimer's (BNA) and the Meotis Network, to conduct a comparative trial between patients who stopped anticholinesterase medication after its withdrawal from the market and those who continued the anticholinesterase medication. The authors called the method "shooting trial simulation".as close as possible to the methodological standards of randomized clinical trials.This means that biases are often introduced when observational studies are not so rigorously designed from the start."
After 1 and 4 years, among the included patients (5,771 from BNA and 708 from Meotis), the researchers observed a mean difference in MMSE score decline between deceased (n=1,177 and 180) and survivors (n=6,142 and 649) of 0.97 and 181 points, respectively.Team groups over a 5-year period (RR = 1.10) report no significant difference in mortality between.The results, "like the DOMINO experiment [from which their method is inspired, editor's note] confirming the benefits of this treatment, this time in the long term, and their relatively good safety, Dr. Simon Lasserf, the first author of the study and a neurologist, allowed us to expand our data at the Memory Center than at the DOM from Lille.Continuation of donepezil in patients with moderate to severe disease showed that this anticholinesterase improved the MMSE score by approximately 2 points after 1 year.
Do not refuse symptomatic treatment
The authors were able to identify a "temporary decrease" after stopping anticholinesterase drugs.“The difference in MMSE appeared rapidly in the first month and then plateaued [...].This indicates a main effect of symptoms instead of disease modification, which, however, remains long-lasting," they analyze.
Although symptomatic treatments such as anticholinesterase drugs have often been overshadowed by advances in Alzheimer's disease-modifying therapies, "they remain important because of their availability, safety, and modest cognitive benefits but can be produced in mild to moderate doses."In the context of the withdrawal of anticholinesterase drugs in 2018 in France, we read that "a clear negative psychological effect of stopping treatment without compensatory benefits in terms of death or adverse effects" has emerged.
The authors added, "Although only a few patients discontinued treatment, this policy had a significant impact on new prescriptions and follow-up and raised concerns about potential harm to French Alzheimer's patients and their caregivers. Reimbursement policies should be reconsidered in light of this evidence."at the University of Lille.
The team now wants to replicate the same study with data from patients with Lewy body disease, a "disease in which anticholinesterase drugsexpressed interest as well,” concluded Dr. Simon Lecerf.
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