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阿尔茨海默病治疗的联合疗法:最新进展与未来前景。

Combination Therapy for the Treatment of Alzheimer's Disease: Recent Progress and Future Prospects.

机构信息

Institute of Pharmaceutical Sciences, Guru Ghasidas University, Bilaspur, 495 009, (C.G.), India.

Faculty of Pharmacy, AIMST University, Semeling, 08100 Bedong, Kedah Darul Aman, Malaysia.

出版信息

Curr Top Med Chem. 2022;22(22):1849-1867. doi: 10.2174/1568026622666220907114443.

Abstract

BACKGROUND

The management of Alzheimer's disease is challenging due to its complexity. However, the currently approved and marketed treatments for this neurodegenerative disorder revolves around cholinesterase inhibitors, glutamate regulators, or the combination of these agents. Despite the prompt assurance of many new drugs, several agents were unsuccessful, especially in phase II or III trials, not meeting efficacy endpoints.

OBJECTIVE

The execution of effective treatment approaches through further trials investigating a rational combination of agents is necessitude for Alzheimer's disease.

METHODS

For this review, more than 248 relevant scientific papers were considered from a variety of databases (Scopus, Web of Science, Google Scholar, ScienceDirect, and PubMed) using the keywords Alzheimer's disease, amyloid-β, combination therapies, cholinesterase inhibitors, dementia, glutamate regulators, AD hypothesis.

RESULT AND DISCUSSION

The researcher's intent is to either develop a disease-modifying therapeutic means for aiming in the early phases of dementia and/or optimize the available symptomatic treatments principally committed to the more advanced stages of Alzheimer's. Since Alzheimer's possesses multifactorial pathogenesis, designing a multimodal therapeutic intervention for targeting different pathological processes of dementia may appear to be the most practical method to alter the course of disease progression.

CONCLUSION

The combination approach may even allow for providing individual agents in lower doses, with reducible costs and side effects. Numerous studies on combination therapy predicted better clinical efficacy than monotherapy. The literature review highlights the major clinical studies (both symptomatic and disease-modifying) conducted in the past decade on combination therapy to combat cognitive disorder.

摘要

背景

由于阿尔茨海默病的复杂性,其管理具有挑战性。然而,目前针对这种神经退行性疾病的批准和上市治疗方法主要围绕乙酰胆碱酯酶抑制剂、谷氨酸调节剂,或这些药物的联合应用。尽管有许多新药迅速问世,但仍有几种药物未能成功,尤其是在 II 期或 III 期临床试验中,未能达到疗效终点。

目的

通过进一步的临床试验,执行有效的治疗方法,探索合理的联合用药,这对于阿尔茨海默病来说是必要的。

方法

为了进行这次综述,研究人员从多个数据库(Scopus、Web of Science、Google Scholar、ScienceDirect 和 PubMed)中考虑了超过 248 篇相关的科学论文,使用的关键词包括阿尔茨海默病、淀粉样蛋白-β、联合治疗、乙酰胆碱酯酶抑制剂、痴呆、谷氨酸调节剂、AD 假说。

结果和讨论

研究人员的目的是为了开发一种针对痴呆早期阶段的疾病修正治疗方法,或者优化现有的主要针对阿尔茨海默病晚期阶段的对症治疗方法。由于阿尔茨海默病具有多因素发病机制,针对痴呆不同病理过程设计一种多模式治疗干预可能是改变疾病进展过程的最实用方法。

结论

联合治疗方法甚至可以允许以较低的剂量使用个别药物,从而降低成本和副作用。许多关于联合治疗的研究预测其临床疗效优于单一疗法。文献综述强调了过去十年中针对联合治疗进行的主要临床研究(包括对症和疾病修正治疗),以对抗认知障碍。

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