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美金刚长期治疗对重度认知障碍患者死亡率的影响：一项系统评价与荟萃分析。

Effect of long-term treatment with memantine on mortality in patients with major cognitive disorders: A systematic review and meta-analysis.

作者信息

Zolnowski-Kolp Victoria, Oquendo Bruno, Havreng-Théry Charlotte, Lafuente-Lafuente Carmelo, Belmin Joël

机构信息

Service de Gériatrie, Hôpital Charles Foix, Assistance Publique-Hôpitaux de Paris Ivry-sur-Seine France.

Laboratoire LIMICS, Sorbonne Université Paris France.

出版信息

Alzheimers Dement (N Y). 2025 Apr 19;11(2):e70071. doi: 10.1002/trc2.70071. eCollection 2025 Apr-Jun.

DOI:10.1002/trc2.70071
PMID:40256206
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12009441/
Abstract

BACKGROUND

Dementia is responsible for a reduction in life expectancy, and the effect of memantine on mortality is still poorly understood. Our aim was to evaluate the effect of long-term treatment with memantine on all-cause mortality.

METHODS

In this systematic review and meta-analysis, we searched five databases from their creation to June 2024.

RESULTS

We found 12 randomized trials ( = 4266) and 7 observational studies ( = 20,216). Treatment with memantine was associated with a reduction in all-cause mortality (risk ratios [RRs] 0.81, 95% CI: 0.72-0.92,  = 0.001). In the sensitivity analysis, the pooled RR was similar for randomized controlled trials (RCT) (RR 0.86) and non-randomized studies (RR 0.81) but pooled results from RCTs did not reach statistical significance (95% confidence interval [CI]: 0.59-1.26,  = 0.45), while they did for observational studies (95% CI: 0.70-0.95,  = 0.008), so we consider the overall evidence as of low certainty.

CONCLUSION

Our results suggest that the use of memantine in patients with dementia may be associated with a reduction in all-cause mortality.

HIGHLIGHTS

Dementia reduces patients' survival and the effect of long-term use of memantine on all-cause mortality is not well known.This systematic review and metanalysis included 19 studies including more than 24000 patients.We found that memantine in patients with dementia may be associated with a reduction in all-cause mortality.

摘要

背景

痴呆会导致预期寿命缩短，而美金刚对死亡率的影响仍知之甚少。我们的目的是评估长期使用美金刚治疗对全因死亡率的影响。

方法

在这项系统评价和荟萃分析中，我们检索了五个数据库，时间跨度从其创建至2024年6月。

结果

我们找到了12项随机试验（n = 4266）和7项观察性研究（n = 20216）。美金刚治疗与全因死亡率降低相关（风险比[RRs]为0.81，95%置信区间：0.72 - 0.92，P = 0.001）。在敏感性分析中，随机对照试验（RCT）（RR 0.86）和非随机研究（RR 0.81）的合并RR相似，但RCT的合并结果未达到统计学显著性（95%置信区间[CI]：0.59 - 1.26，P = 0.45），而观察性研究的合并结果达到了统计学显著性（95% CI：0.70 - 0.95，P = 0.008），所以我们认为总体证据的确定性较低。

结论

我们的结果表明，在痴呆患者中使用美金刚可能与全因死亡率降低相关。

要点

痴呆会降低患者的生存率，长期使用美金刚对全因死亡率的影响尚不明确。这项系统评价和荟萃分析纳入了19项研究，涉及超过24000名患者。我们发现，痴呆患者使用美金刚可能与全因死亡率降低相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9305/12009441/6518e2ac2751/TRC2-11-e70071-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9305/12009441/eed9f76af6be/TRC2-11-e70071-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9305/12009441/625cc2dbc2d2/TRC2-11-e70071-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9305/12009441/6518e2ac2751/TRC2-11-e70071-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9305/12009441/eed9f76af6be/TRC2-11-e70071-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9305/12009441/625cc2dbc2d2/TRC2-11-e70071-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9305/12009441/6518e2ac2751/TRC2-11-e70071-g001.jpg

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本文引用的文献

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Cholinesterase inhibitors and memantine are associated with a reduced mortality in nursing home residents with dementia: a longitudinal observational study.胆碱酯酶抑制剂和美金刚与养老院痴呆患者的死亡率降低相关：一项纵向观察研究。
Alzheimers Res Ther. 2024 May 29;16(1):117. doi: 10.1186/s13195-024-01481-0.
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Trends of use and characterisation of anti-dementia drugs users: a large multinational-network population-based study.抗痴呆药物使用者的使用趋势和特征：一项大型跨国网络基于人群的研究。
Age Ageing. 2024 May 1;53(5). doi: 10.1093/ageing/afae106.
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Memantine: Updating a rare success story in pro-cognitive therapeutics.
美金刚：认知治疗中的罕见成功案例更新。
Neuropharmacology. 2024 Feb 15;244:109737. doi: 10.1016/j.neuropharm.2023.109737. Epub 2023 Oct 11.
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Basic information about memantine and its treatment of Alzheimer's disease and other clinical applications.美金刚的基本信息及其对阿尔茨海默病的治疗和其他临床应用。
Ibrain. 2023 Jun 6;9(3):340-348. doi: 10.1002/ibra.12098. eCollection 2023 Fall.
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Prevalence of treated patients with Alzheimer's disease: current trends and COVID-19 impact.阿尔茨海默病治疗患者的患病率：当前趋势和 COVID-19 的影响。
Alzheimers Res Ther. 2023 Aug 3;15(1):130. doi: 10.1186/s13195-023-01271-0.
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Association between antidementia medication use and mortality in people diagnosed with dementia with Lewy bodies in the UK: A retrospective cohort study.在英国，诊断为路易体痴呆的人群中使用抗痴呆药物与死亡率之间的关联：一项回顾性队列研究。
PLoS Med. 2022 Dec 6;19(12):e1004124. doi: 10.1371/journal.pmed.1004124. eCollection 2022 Dec.
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Lecanemab in Early Alzheimer's Disease.早期阿尔茨海默病中的lecanemab
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Mortality rates in Alzheimer's disease and non-Alzheimer's dementias: a systematic review and meta-analysis.阿尔茨海默病和非阿尔茨海默痴呆症的死亡率：系统评价和荟萃分析。
Lancet Healthy Longev. 2021 Aug;2(8):e479-e488. doi: 10.1016/S2666-7568(21)00140-9. Epub 2021 Jul 21.
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