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A systematic review of the clinical effectiveness of donepezil, rivastigmine and galantamine on cognition, quality of life and adverse events in Alzheimer's disease.
Int J Geriatr Psychiatry 2006; 21(1):17-28IJ

Abstract

BACKGROUND

The use of cholinesterase inhibitors for Alzheimer's disease (AD) is currently being appraised by the National Institute for Clinical Evidence (NICE). This article provides the latest evidence that NICE will be using as part of this appraisal process.

OBJECTIVE

To provide a systematic review of the best quality evidence of the effects of donepezil, rivastigmine and galantamine on cognition, quality of life and adverse events in people with mild to moderately-severe AD.

DESIGN

Electronic databases were searched, references of all retrieved articles were checked, and experts were contacted for advice, peer review and to identify additional references. Randomised controlled trials (RCTs) were included if they fulfilled pre-specified criteria. Data were synthesised through a narrative review.

RESULTS

Twenty-six RCTs that compared any one of the cholinesterase inhibitors with either a control group or with another cholinesterase inhibitor were included. The quality of reporting and methodology was varied. Treatment with donepezil, rivastigmine or galantamine resulted in significantly better cognitive performance using the ADAS-cog scale when compared with placebo. These findings were generally supported using the MMSE scale. Results from head to head comparisons were limited by the low number of studies and the study quality; generally showing no robust support for any one drug. Few studies evaluated quality of life. Adverse events were generally related to the gastrointestinal system, with a tendency for these to be more common in the treatment arms.

CONCLUSIONS

The cholinesterase inhibitors donepezil, rivastigmine, and galantamine can delay cognitive impairment in patients with mild to moderately-severe AD for at least 6 months duration.

Authors+Show Affiliations

Southampton Health Technology Assessments Centre (SHTAC), University of Southampton, Southampton, UK.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

16323253

Citation

Takeda, A, et al. "A Systematic Review of the Clinical Effectiveness of Donepezil, Rivastigmine and Galantamine On Cognition, Quality of Life and Adverse Events in Alzheimer's Disease." International Journal of Geriatric Psychiatry, vol. 21, no. 1, 2006, pp. 17-28.
Takeda A, Loveman E, Clegg A, et al. A systematic review of the clinical effectiveness of donepezil, rivastigmine and galantamine on cognition, quality of life and adverse events in Alzheimer's disease. Int J Geriatr Psychiatry. 2006;21(1):17-28.
Takeda, A., Loveman, E., Clegg, A., Kirby, J., Picot, J., Payne, E., & Green, C. (2006). A systematic review of the clinical effectiveness of donepezil, rivastigmine and galantamine on cognition, quality of life and adverse events in Alzheimer's disease. International Journal of Geriatric Psychiatry, 21(1), pp. 17-28.
Takeda A, et al. A Systematic Review of the Clinical Effectiveness of Donepezil, Rivastigmine and Galantamine On Cognition, Quality of Life and Adverse Events in Alzheimer's Disease. Int J Geriatr Psychiatry. 2006;21(1):17-28. PubMed PMID: 16323253.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A systematic review of the clinical effectiveness of donepezil, rivastigmine and galantamine on cognition, quality of life and adverse events in Alzheimer's disease. AU - Takeda,A, AU - Loveman,E, AU - Clegg,A, AU - Kirby,J, AU - Picot,J, AU - Payne,E, AU - Green,C, PY - 2005/12/3/pubmed PY - 2006/8/2/medline PY - 2005/12/3/entrez SP - 17 EP - 28 JF - International journal of geriatric psychiatry JO - Int J Geriatr Psychiatry VL - 21 IS - 1 N2 - BACKGROUND: The use of cholinesterase inhibitors for Alzheimer's disease (AD) is currently being appraised by the National Institute for Clinical Evidence (NICE). This article provides the latest evidence that NICE will be using as part of this appraisal process. OBJECTIVE: To provide a systematic review of the best quality evidence of the effects of donepezil, rivastigmine and galantamine on cognition, quality of life and adverse events in people with mild to moderately-severe AD. DESIGN: Electronic databases were searched, references of all retrieved articles were checked, and experts were contacted for advice, peer review and to identify additional references. Randomised controlled trials (RCTs) were included if they fulfilled pre-specified criteria. Data were synthesised through a narrative review. RESULTS: Twenty-six RCTs that compared any one of the cholinesterase inhibitors with either a control group or with another cholinesterase inhibitor were included. The quality of reporting and methodology was varied. Treatment with donepezil, rivastigmine or galantamine resulted in significantly better cognitive performance using the ADAS-cog scale when compared with placebo. These findings were generally supported using the MMSE scale. Results from head to head comparisons were limited by the low number of studies and the study quality; generally showing no robust support for any one drug. Few studies evaluated quality of life. Adverse events were generally related to the gastrointestinal system, with a tendency for these to be more common in the treatment arms. CONCLUSIONS: The cholinesterase inhibitors donepezil, rivastigmine, and galantamine can delay cognitive impairment in patients with mild to moderately-severe AD for at least 6 months duration. SN - 0885-6230 UR - https://www.unboundmedicine.com/medline/citation/16323253/A_systematic_review_of_the_clinical_effectiveness_of_donepezil_rivastigmine_and_galantamine_on_cognition_quality_of_life_and_adverse_events_in_Alzheimer's_disease_ L2 - https://doi.org/10.1002/gps.1402 DB - PRIME DP - Unbound Medicine ER -