Glynn-Servedio Brianna E, Ranola Trisha Seys
Consult Pharm. 2017 Sep 1;32(9):511-518. doi: 10.4140/TCP.n.2017.511.
The objective of this article is to review the available evidence for duration of treatment with, and considerations for discontinuation of, acetylcholinesterase inhibitors and N-methyl-d-aspartate receptor antagonists in Alzheimer's disease.
Literature searches of clinical trials and meta-analyses were conducted using PubMed with the search terms Alzheimer's, dementia, donepezil, galantamine, memantine, and rivastigmine. References from included trials were also used to find additional citations.
STUDY SELECTION/DATA EXTRACTION: 2,925 articles were initially identified. Twenty-one studies were included that looked at the use of acetylcholinesterase inhibitors and/or memantine in the treatment of moderate-to-severe Alzheimer's dementia.
Several clinical trials have demonstrated small improvements in measures of cognition and activities of daily living with medications used to treat dementia. However, not all patients will benefit from treatment, and the impact of treatment on long-term outcomes, including institutionalization, remains unclear. This paper reviews the available data to support the use of acetylcholinesterase inhibitors and/or memantine in patients with advanced Alzheimer's disease, including those in nursing facilities, and reviews recommendations for consideration of therapy discontinuation.
The evidence to support a specific time frame for discontinuation of Alzheimer's disease treatment is limited. It is reasonable to stop a medication if there is no noticeable benefit after the first three months of treatment or once a patient's dementia progresses to a point where there would be no meaningful benefit from continued therapy.
本文旨在综述有关阿尔茨海默病中乙酰胆碱酯酶抑制剂和N-甲基-D-天冬氨酸受体拮抗剂治疗时长的现有证据以及停药考量因素。
使用PubMed对临床试验和荟萃分析进行文献检索，检索词为阿尔茨海默病、痴呆、多奈哌齐、加兰他敏、美金刚和卡巴拉汀。纳入试验的参考文献也用于查找其他引用文献。
研究选择/数据提取：最初识别出2925篇文章。纳入了21项研究，这些研究观察了乙酰胆碱酯酶抑制剂和/或美金刚在中重度阿尔茨海默病痴呆治疗中的应用。
多项临床试验表明，用于治疗痴呆的药物在认知和日常生活活动指标方面有小幅改善。然而，并非所有患者都能从治疗中获益，而且治疗对包括入住机构护理等长期结局的影响仍不明确。本文综述了现有数据，以支持在晚期阿尔茨海默病患者（包括那些在护理机构中的患者）中使用乙酰胆碱酯酶抑制剂和/或美金刚，并综述了关于考虑停药的建议。
支持设定阿尔茨海默病治疗停药具体时间框架的证据有限。如果在治疗的前三个月后没有明显益处，或者一旦患者的痴呆进展到继续治疗不会有显著获益的程度，停止用药是合理的。
