Monotherapy Is Good Enough for Patients With Mild‐to‐Moderate Alzheimer's Disease: A Network Meta‐Analysis of 76 Randomized Controlled Trials

Tsoi, Kelvin K.F.; Chan, Joyce Y.C.; Chan, Felix C.H.; Hirai, Hoyee W.; Wong, Samuel Yeung Shan

doi:10.1002/cpt.1104

Cited by 21 publications

(9 citation statements)

References 48 publications

(62 reference statements)

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“…We are aware of three studies associated with AD that also integrated direct and indirect comparisons simultaneously in one network meta-analysis (Dou et al, 2018;Thancharoen and Limwattananon, 2019;Tsoi et al, 2019). In contrast to these previous studies, our study included new interventions and integrated all available high-quality RCTs with regard to the effectiveness, acceptability, and safety of cognitive enhancers in treating mild to moderate AD in one analysis, while examining different doses of treatments as independent interventions.…”

Section: Discussionmentioning

confidence: 99%

Different Doses of Pharmacological Treatments for Mild to Moderate Alzheimer’s Disease: A Bayesian Network Meta-Analysis

et al. 2020

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Background: 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.Methods: 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 Ginkgo biloba extract EGb761, alone or in combination, were identified. The primary outcomes were efficacy, acceptability, and safety.Results: 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 2 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.Conclusions: Different doses of the tested pharmacological interventions yielded benefits with regard to cognition, acceptability, safety, function, and clinical global impressions, but not effective behaviors.

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Section: Discussionmentioning

confidence: 99%

Different Doses of Pharmacological Treatments for Mild to Moderate Alzheimer’s Disease: A Bayesian Network Meta-Analysis

et al. 2020

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“…22,[65][66][67] Donepezil in oral form and rivastigmine transdermal patches have received regulatory approval for the treatment of all stages of AD ranging from mild to severe. 19,22,[68][69][70][71][72][73][74][75][76][77][78][79][80] There is no significant difference between the efficacy of these AChEIs in terms of improving psychometric and cognitive scales. 81 However, three AChEIs differ in both PK and PD properties, [82][83][84] as shown in Supplementary Table 1.…”

Section: Dovepressmentioning

confidence: 99%

Adverse Drug Reactions of Acetylcholinesterase Inhibitors in Older People Living with Dementia: A Comprehensive Literature Review

Ruangritchankul¹,

Chantharit²,

Srisuma³

et al. 2021

TCRM

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The rising of global geriatric population has contributed to increased prevalence of dementia. Dementia is a neurodegenerative disease, which is characterized by progressive deterioration of cognitive functions, such as judgment, language, memory, attention and visuospatial ability. Dementia not only has profoundly devastating physical and psychological health outcomes, but it also poses a considerable healthcare expenditure and burdens. Acetylcholinesterase inhibitors (AChEIs), or so-called anti-dementia medications, have been developed to delay the progression of neurocognitive disorders and to decrease healthcare needs. AChEIs have been widely prescribed in clinical practice for the treatment of Alzheimer's disease, which account for 70% of dementia. The rising use of AChEIs results in increased adverse drug reactions (ADRs) such as cardiovascular and gastrointestinal adverse effects, resulting from overstimulation of peripheral cholinergic activity and muscarinic receptor activation. Changes in pharmacokinetics (PK), pharmacodynamics (PD) and pharmacogenetics (PGx), and occurrence of drug interactions are said to be major risk factors of ADRs of AChEIs in this population. To date, comprehensive reviews in ADRs of AChEIs have so far been scarcely studied. Therefore, we aimed to recapitulate and update the diverse aspects of AChEIs, including the mechanisms of action, characteristics and risk factors of ADRs, and preventive strategies of their ADRs. The collation of this knowledge is essential to facilitate efforts to reduce ADRs of AChEIs.

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“…The primary endpoint was scores on the SMMSE (0-30, with higher scores indicative of better cognitive function) throughout the study period. 21 The secondary endpoints were scores on the Bristol Activities of Daily Living Scale (BADLS; 0-60, with higher scores indicative of greater impairment), 22 the Neuropsychiatric Inventory (NPI; 0-144, with higher scores indicative of elevated behavioral and psychological symptoms), 23 the dementia quality of life (DEMQOL)-Proxy (31-134, with higher scores indicative of better patient health-related quality of life), 24 and the General Health Questionnaire 12 (GHQ-12; 0-12, with higher scores indicative of elevated psychological symptoms in nonprofessional caregivers), throughout the study period. 25 All evaluations were performed by the chief physicians in our hospital for all included patients.…”

Section: Outcome Measuresmentioning

confidence: 99%

Donepezil plus memantine versus donepezil alone for treatment of concomitant Alzheimer’s disease and chronic obstructive pulmonary disease: a retrospective observational study

Cao

Liang

et al. 2020

J Int Med Res

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Objective: To assess the clinical outcomes of donepezil plus memantine (DM) and donepezil (DO) alone in Asian patients with a concomitant diagnosis of moderate-to-severe Alzheimer's disease and mild-to-moderate chronic obstructive pulmonary disease (AD-COPD). Methods: We conducted a retrospective analysis of patients with AD-COPD who received either DM or DO for 6 months, or until the occurrence of unacceptable adverse events or disease progression, between June 2012 and May 2016. The primary endpoint was the score on the Standardized Mini-Mental State Examination (SMMSE). Secondary endpoints were scores on the caregiver-rated Bristol Activities of Daily Living Scale, Neuropsychiatric Inventory,

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Monotherapy Is Good Enough for Patients With Mild‐to‐Moderate Alzheimer's Disease: A Network Meta‐Analysis of 76 Randomized Controlled Trials

Cited by 21 publications

References 48 publications

Different Doses of Pharmacological Treatments for Mild to Moderate Alzheimer’s Disease: A Bayesian Network Meta-Analysis

Different Doses of Pharmacological Treatments for Mild to Moderate Alzheimer’s Disease: A Bayesian Network Meta-Analysis

Adverse Drug Reactions of Acetylcholinesterase Inhibitors in Older People Living with Dementia: A Comprehensive Literature Review

Donepezil plus memantine versus donepezil alone for treatment of concomitant Alzheimer’s disease and chronic obstructive pulmonary disease: a retrospective observational study

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