Zhang Tingting, Liu Nanyang, Cao Hongfu, Wei Wei, Ma Lina, Li Hao
College of First Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China.
Department of Geratology, Xiyuan Hospital, China Academy of Chinese Medical Science, Beijing, China.
Front Pharmacol. 2020 May 26;11:778. doi: 10.3389/fphar.2020.00778. eCollection 2020.
Pharmacological treatments play a significant role in treating mild to moderate Alzheimer's disease (AD), but the optimal doses of various drugs used for these treatments are unknown. Our study compared the efficacy, acceptability, and safety of different doses of pharmacological treatments for mild to moderate AD.
Randomized controlled trials (RCTs) were identified by searching the PubMed, EMBASE, and Cochrane Library databases (all RCTs published from the date of inception of the databases until September 19, 2019). Trials comparing the efficacy, acceptability, and safety of pharmacological interventions involving donepezil, galantamine, rivastigmine, memantine, huperzine A, and extract EGb761, alone or in combination, were identified. The primary outcomes were efficacy, acceptability, and safety.
Our meta-analysis included 37 studies involving 14,705 participants. In terms of improving cognitive function, galantamine 32 mg, galantamine 24 mg, donepezil 5 mg, and donepezil 10 mg were more effective than other interventions, with the surface under the cumulative ranking curve (SUCRA) values of 93.2, 75.5, 73.3, and 65.6%, respectively. According to the SUCRA values, EGb761 240 mg was considered to be the optimal intervention in terms of both acceptability and safety. With regard to clinical global impression, rivastigmine 12 mg had the highest probability of being ranked first (83.7%). The rivastigmine 15 cm patch (SUCRA = 93.7%) may be the best choice for daily living. However, there were no interventions that could significantly improve neuropsychiatric symptoms, compared with the placebo.
Different doses of the tested pharmacological interventions yielded benefits with regard to cognition, acceptability, safety, function, and clinical global impressions, but not effective behaviors.
药物治疗在轻至中度阿尔茨海默病（AD）的治疗中发挥着重要作用，但用于这些治疗的各种药物的最佳剂量尚不清楚。我们的研究比较了不同剂量的药物治疗轻至中度AD的疗效、可接受性和安全性。
通过检索PubMed、EMBASE和Cochrane图书馆数据库（从数据库建立之日至2019年9月19日发表的所有随机对照试验[RCT]）来识别RCT。识别比较多奈哌齐、加兰他敏、卡巴拉汀、美金刚、石杉碱甲和EGb761提取物单独或联合使用的药物干预的疗效、可接受性和安全性的试验。主要结局为疗效、可接受性和安全性。
我们的荟萃分析纳入了37项研究，涉及14705名参与者。在改善认知功能方面，32 mg加兰他敏、24 mg加兰他敏、5 mg多奈哌齐和10 mg多奈哌齐比其他干预措施更有效，累积排序曲线下面积（SUCRA）值分别为93.2%、75.5%、73.3%和65.6%。根据SUCRA值，240 mg EGb761在可接受性和安全性方面被认为是最佳干预措施。关于临床总体印象，12 mg卡巴拉汀排在首位的概率最高（83.7%）。15 cm卡巴拉汀贴片（SUCRA = 93.7%）可能是日常生活的最佳选择。然而，与安慰剂相比，没有干预措施能显著改善神经精神症状。
不同剂量的受试药物干预在认知、可接受性、安全性、功能和临床总体印象方面产生了益处，但对行为无效。
