The Plasma Cholinesterase Activity as a Marker of Effectiveness of Rivastigmine
Misa Hosoi1, Koji Hori2*, Hiroi Tomioka1, Kimiko Konishi3, Michiho Sodenaga2 and Mitsugu Hachisu4
1Department of Psychiatry, Showa University Northern Yokohama Hospital, Japan
2Department of Neuropsychiatry, St. Marianna University School of Medicine, Japan
3Tokyo Metropolitan Tobu Medical Center for Persons with Developmental/ Multiple Disabilities, Japan
4Department of Pharmaceutical Therapeutics, Showa University, Tokyo, Japan
Submission: April 17, 2017; Published: June 01, 2017
*Corresponding author: Koji Hori, Department of Neuropsychiatry, St. Marianna University School of Medicine, Japan, Tel: +81-44-977-8111;Fax: +81-44-976-33;Email: kojihori@marianna-u.ac.jp
How to cite this article: Misa H, Koji H, Hiroi T, Kimiko K, Michiho S, Mitsugu H. The Plasma Cholinesterase Activity as a Marker of Effectiveness of Rivastigmine. Theranostics Brain Spine Neuro Disord. 2017; 1(2): 555559. DOI: 10.19080/TBSND.2017.01.555559
Opinion
In Japan, three medicines are available as a cholinesterase inhibitor for mild to moderate stage in Alzheimer's type dementia, i.e. donepezil, galantamine and rivastigmine. In Japan, donepezil was allowed in 1999 and other two medicines were allowed in 2011. Therefore, main separation of these three medicines is those between donepezil and (rivastigmine or galantamine). In this article we note the separation between donepezil and rivastigmine.
There is no convention and rule for using these three medicines for different purposes. Of course no separation between donepezil and rivastigmine. In fact, physicians are not conscious about the differentiation of these three medicines. It is only emphasized that rivastigmine is available as patch type and two medicines are available as oral administration type. Therefore, in the situation of prescription of rivastigmine, it is emphasized that we should prescribe rivastigmine when the patient refuse to take medicine. It is also emphasized that in order to be calm, it is important for patients and their caregivers, we should provide the opportunity providing them skin ship (direct contact between them and their caregivers thought facial shins)". These opinions are right. However, we consider that rivastigmine is unique that this medicine has an inhibitory actions both acetylcholinesterase (AChE) activity and butyrylcholinesterase (BuChE) activity although donepezil has an inhibitory actions only AChE activity not BuChE activity [1]. Of course galantamine also has an inhibitory actions only AChE activity not BuChE activity as is donepezil. Therefore we emphasize that we should separate donepezil and rivastigmine in view of BuChE activity [2]. Moreover, plasma cholinesterase (p-ChE) is known as a nonspecific cholinesterase enzyme that hydrolyses many different choline-based esters. Therefore, p-ChE is not the AChE but BuCh [3]. We should evaluate p-ChE when we prescribe rivastigmine. Until now it is considered that because high p-ChE activity is related with low grade inflammation [4], down regulation of p-ChE activity is important to recover cognitive function and to ameliorate behavioral symptoms [5]. However, because p-ChE is related with detoxication and antioxidant property [6], low grade p-ChE activity is related with frail, too much lower p-ChE activity is not favor for physical condition and mental state [7]. Therefore, we consider that it is important to keep inside a certain range.
Conflict of Interest
Koji Hori received lecture fees from Eisai Co. Ltd., Pfizer Japan Inc., Novartis Pharma KK, Daiichi Sankyo Inc., Ono Pharmaceutical Co. Ltd., Janssen Pharmaceutical KK, Yoshitomi Yakuhin Co. Meiji Seika Pharma Co. Ltd., and Mitsubishi Tanabe Pharma Co. Mitsugu Hachisu received lecture fees from Meiji Seika Pharma Co. Ltd. and Mitsubishi Tanabe Pharma Co. However, the sponsors had no role in study design, data collection and analysis including our before presented articles, decision to publish, or preparation of this manuscript.
Disclosure Statement
Koji Hori funding from Ito Memorial Foundation. Mitsugu Hachisu received funding from Astellas Pharma Inc., Meiji Seika Pharma Co. Ltd., Dainippon Sumitomo Pharm Co. Ltd., Eli Lilly Japan KK, and Shionogi & Co. Ltd. However, these funding are not used for this article.
Author Contributions
Koji Hori coordinated the study about the relationships between plasma cholinesterase activity and cognitive function in Alzheimer's disease. Misa Hosoi mainly analyzed the data in this work and wrote the manuscript. Kimiko Konishi, Michiho Sodenaga and Mitsugu Hachisu gave idea about this relations in demented patients. Kimiko Konishi, Michiho Sodenaga and Mitsugu Hachisu also checked the manuscript.
Acknowledgment
Dr. Chiaki Hashimoto (St. Mariana University School of Medicine, Department of Neuropsychiatry, Kawasaki, Japan), Dr. Mioto Maedomari (St. Mariana University Yokohama Western Hospital, Department of Neuropsychiatry, Yokohama, Japan), Dr. Ouga Sasaki (St. Mariana University School of Medicine, Department of Neuropsychiatry, Kawasaki, Japan), Dr. Itsuku Suziki (Kawasaki Municipal Tama Hospital, Department of Neuropsychiatry Kawasaki, Japan) and Dr. Hiroyuki Kamatani (Kawasaki Memorial Hospital Department of Psychiatry, Kawasaki, Japan) are other member in study group of geropsychiatry in St. Mariana University School of Medicine for studies in geropsychiatric patients.
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