Hansen Richard A, Gartlehner Gerald, Webb Aaron P, Morgan Laura C, Moore Charity G, Jonas Daniel E
School of Pharmacy, Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Clin Interv Aging. 2008;3(2):211-25.
Pharmacologic treatments for Alzheimer's disease include the cholinesterase inhibitors donepezil, galantamine, and rivastigmine. We reviewed their evidence by searching MEDLINE, Embase, The Cochrane Library, and the International Pharmaceutical Abstracts from 1980 through 2007 (July) for placebo-controlled and comparative trials assessing cognition, function, behavior, global change, and safety. Thirty-three articles on 26 studies were included in the review. Meta-analyses of placebo-controlled data support the drugs' modest overall benefits for stabilizing or slowing decline in cognition, function, behavior, and clinical global change. Three open-label trials and one double-blind randomized trial directly compared donepezil with galantamine and rivastigmine. Results are conflicting; two studies suggest no differences in efficacy between compared drugs, while one study found donepezil to be more efficacious than galantamine, and one study found rivastigmine to be more efficacious than donepezil. Adjusted indirect comparison of placebo-controlled data did not find statistically significant differences among drugs with regard to cognition, but found the relative risk of global response to be better with donepezil and rivastigmine compared with galantamine (relative risk = 1.63 and 1.42, respectively). Indirect comparisons also favored donepezil over galantamine with regard to behavior. Across trials, the incidence of adverse events was generally lowest for donepezil and highest for rivastigmine.
用于治疗阿尔茨海默病的药物包括胆碱酯酶抑制剂多奈哌齐、加兰他敏和卡巴拉汀。我们通过检索1980年至2007年7月的MEDLINE、Embase、Cochrane图书馆和国际药学文摘，以查找评估认知、功能、行为、整体变化和安全性的安慰剂对照试验和比较试验，从而对这些药物的证据进行了综述。该综述纳入了关于26项研究的33篇文章。对安慰剂对照数据的荟萃分析支持这些药物在稳定或减缓认知、功能、行为和临床整体变化方面具有适度的总体益处。三项开放标签试验和一项双盲随机试验直接比较了多奈哌齐与加兰他敏和卡巴拉汀。结果相互矛盾；两项研究表明，所比较的药物在疗效上没有差异，而一项研究发现多奈哌齐比加兰他敏更有效，另一项研究发现卡巴拉汀比多奈哌齐更有效。对安慰剂对照数据进行调整后的间接比较未发现各药物在认知方面存在统计学上的显著差异，但发现与加兰他敏相比，多奈哌齐和卡巴拉汀的总体反应相对风险更好（相对风险分别为1.63和1.42）。间接比较在行为方面也更倾向于多奈哌齐而非加兰他敏。在各项试验中，多奈哌齐的不良事件发生率总体最低，卡巴拉汀的最高。
