Department of Neurology, Qingdao Municipal Hospital, Qingdao University, No. 5 Donghai Middle Road, Qingdao, China.
Clinical Research Center, Qingdao Municipal Hospital, Qingdao University, Qingdao, China.
Alzheimers Res Ther. 2018 Dec 27;10(1):126. doi: 10.1186/s13195-018-0457-9.
Cholinesterase inhibitors and memantine have been approved for management of Alzheimer's disease (AD), but there has been no consensus about the choice of various types and doses of drugs at different stages. Hence, we compared and ranked the efficacy and tolerability of these available drugs.
We searched PubMed, the Cochrane Central Register of Controlled Trials, and Embase for randomized controlled trials (RCTs) published from database inception to July 21, 2017. The primary outcomes were the mean overall changes in cognitive function and responders who had any adverse events. We conducted a random-effects network meta-analysis.
Forty-one RCTs were included in this study. Compared with placebo, galantamine 32 mg daily (standardized mean difference - 0.51, 95% credible interval - 0.67 to - 0.35), galantamine 24 mg daily (- 0.50, - 0.61 to - 0.40), and donepezil 10 mg daily (- 0.40, - 0.51 to - 0.29) were probably the most effective agents on cognition for mild to moderate AD, and memantine 20 mg combined with donepezil 10 mg (0.76, 0.39 to 1.11) was recommended for moderate to severe patients. Memantine showed the best profile of acceptability. Rivastigmine transdermal 15-cm patch was the best optional treatment both in function and global changes. None of the medicines was likely to improve neuropsychiatric symptoms through this analysis.
Pharmacological interventions have beneficial effects on cognition, function, and global changes, but not on neuropsychiatric symptoms, through current network meta-analysis. The choice of drugs may mainly depend on the disease severity and clinical symptoms.
乙酰胆碱酯酶抑制剂和盐酸美金刚已被批准用于治疗阿尔茨海默病（AD），但对于在不同阶段选择各种类型和剂量的药物尚未达成共识。因此，我们比较并评估了这些现有药物的疗效和耐受性。
我们检索了 PubMed、Cochrane 对照试验中心注册库和 Embase 数据库，检索时间为建库至 2017 年 7 月 21 日。主要结局指标为认知功能总体变化的平均值和发生任何不良反应的应答者。我们进行了随机效应网络荟萃分析。
本研究共纳入 41 项 RCT。与安慰剂相比，加兰他敏 32mg 每日（标准化均数差-0.51，95%可信区间-0.67 至-0.35）、加兰他敏 24mg 每日（-0.50，-0.61 至-0.40）和多奈哌齐 10mg 每日（-0.40，-0.51 至-0.29）可能是治疗轻至中度 AD 认知功能最有效的药物，而对于中重度患者，推荐使用盐酸美金刚 20mg 联合多奈哌齐 10mg（0.76，0.39 至 1.11）。美金刚的可接受性最好。利伐斯的明透皮 15cm 贴片在功能和总体变化方面是最佳的选择。通过本次分析，没有一种药物可能改善神经精神症状。
通过当前的网络荟萃分析，药物干预对认知、功能和总体变化有有益的影响，但对神经精神症状没有影响。药物的选择可能主要取决于疾病的严重程度和临床症状。
