Trends and determinants of choline alfoscerate use in newly diagnosed Alzheimer's disease patients in Korea

BACKGROUND

Choline alfoscerate, a cholinergic precursor, is widely used in Korea for dementia-related symptoms and is covered by national health insurance (NHI). This study investigates the utilization trends and factors influencing choline alfoscerate prescription in newly diagnosed Alzheimer's disease (AD) patients using real-world data.

METHODS

We analyzed data from the Health Insurance Review and Assessment Service (HIRA) for patients aged 60 years and older who were newly diagnosed with AD between 2012 and 2019. Patients with prescriptions for acetylcholinesterase inhibitors (AChEIs) or memantine within 60 days of diagnosis were included. Choline alfoscerate utilization was defined as prescriptions within 60 days of initial diagnosis. Factors influencing its use were identified through multiple logistic regression analyses, and trends over time were assessed using the Cochran–Armitage Trend test.

RESULTS

Among the 330,326 study participants, 99,845 (33.08%) were prescribed choline alfoscerate, with usage increasing from 15.96% in 2012 to 47.65% in 2019. Factors positively associated with its use included male sex, MedAid insurance, and osteoarthritis. Conversely, usage decreased with comorbidities such as hypertension, congestive heart failure, stroke/transient ischemic attack, chronic kidney disease, and depression.

CONCLUSION

Choline alfoscerate usage in Korea has significantly increased, partly due to its national insurance coverage and the absence of disease-modifying therapies for AD. Given the uncertain efficacy and potential risks of choline alfoscerate, continuous monitoring and rigorous evaluation of its long-term benefits and safety are essential. Further research is necessary to establish definitive evidence for its effectiveness and guide its therapeutic use in AD management.

Highlights

• Choline alfoscerate usage among newly diagnosed AD patients in Korea increased from 15.96% in 2012 to 47.65% in 2019.
• Male sex (OR = 1.05) and MedAid insurance coverage (OR = 1.07) were associated with higher odds of choline alfoscerate usage.
• Usage was more likely in patients with osteoarthritis (OR = 1.05) and less likely among those with hypertension (OR = 0.96), stroke/TIA (OR = 0.80), chronic kidney disease (OR = 0.80), and depression (OR = 0.93).
• Patients in rural areas had higher odds of using choline alfoscerate (OR = 1.28) compared to those in metropolitan areas (OR = 1.00).
• Despite limited evidence of efficacy, the extensive use of choline alfoscerate highlights the need for continuous monitoring and rigorous evaluation to ensure its safety and therapeutic value in AD management.