Sistanizad Mohammad, Peterson Gregory M, Ling Tristan, Salahudeen Mohammed Saji, Akondi Vyasa Murthy, Bezabhe Woldesellassie M
University of Tasmania, School of Pharmacy and Pharmacology, Hobart, Australia.
Shahid Beheshti University of Medical Sciences, Faculty of Pharmacy, Tehran, Iran.
Age Ageing. 2025 May 31;54(6). doi: 10.1093/ageing/afaf151.
Suboptimal persistence with anti-dementia drugs (ADDs) in patients with dementia is associated with poorer clinical outcomes, including accelerated disease progression, cognitive decline and increased healthcare utilisation. This study aimed to systematically review real-world persistence rates with ADDs and identify factors influencing persistence.
We followed the Cochrane methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched Medline, Embase, PsycINFO and CINAHL from 1 January 1995 to 5 February 2024. Pooled persistence rates were calculated using random-effects Mantel-Haenszel models. Heterogeneity was assessed using I2 statistics, publication bias via funnel plots and Egger's/Begg's tests, and moderators were explored through meta-regression.
We included 68 studies involving 684,493 participants aged 50 years and older who received ADD. The mean 12-month persistence rate was 49% (95% CI: 42%-56%). Subgroup analyses revealed higher persistence for studies where a permissible gap for medicine refills was not required based on the methodology (67%, 95% CI: 38%-90%), those examining memantine (61%, 95% CI: 38%-82%), studies published between 2011 and 2015 (54%, 95% CI: 41%-68%) and studies conducted in Europe (57%, 95% CI: 43%-71%). Of these, the permissible gap remained an independent predictor of between-study heterogeneity in persistence (β = 0.36, 95% CI: 0.18-0.54).
The meta-analysis demonstrated relatively low persistence to ADDs, which varied according to the evaluation criteria used. Targeted interventions to improve persistence with therapy may lead to better outcomes in patients with dementia. Also, a standardised framework for measuring persistence could improve research reliability.
痴呆症患者对抗痴呆药物（ADDs）的依从性欠佳与较差的临床结局相关，包括疾病进展加速、认知衰退以及医疗保健利用率增加。本研究旨在系统回顾ADDs的实际依从率，并确定影响依从性的因素。
我们遵循Cochrane方法以及系统评价与Meta分析的首选报告项目指南，检索了1995年1月1日至2024年2月5日期间的Medline、Embase、PsycINFO和CINAHL数据库。使用随机效应Mantel-Haenszel模型计算合并依从率。使用I²统计量评估异质性，通过漏斗图和Egger检验/Begg检验评估发表偏倚，并通过Meta回归探索调节因素。
我们纳入了68项研究，涉及684493名50岁及以上接受ADDs治疗的参与者。12个月的平均依从率为49%（95%置信区间：42%-56%）。亚组分析显示，根据研究方法，无需药物再填充允许间隔的研究依从性较高（67%，95%置信区间：38%-90%），研究美金刚的研究（61%，95%置信区间：38%-82%），2011年至2015年发表的研究（54%，95%置信区间：41%-68%）以及在欧洲进行的研究（57%，95%置信区间：43%-71%）。其中，允许间隔仍然是研究间依从性异质性的独立预测因素（β = 0.36，95%置信区间：0.18-0.54）。
Meta分析表明，ADDs的依从性相对较低，且因所使用的评估标准而异。针对性的干预措施以提高治疗依从性可能会使痴呆症患者获得更好的结局。此外，用于衡量依从性的标准化框架可以提高研究的可靠性。
