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Efficacy and safety of donepezil, galantamine, rivastigmine, and memantine for the treatment of Alzheimer's disease: a systematic review and meta-analysis.
J Alzheimers Dis. 2014; 41(2):615-31.JA

Abstract

BACKGROUND

The role of currently available drugs for Alzheimer's disease (AD) has been controversial, with some national formularies restricting their use, and health economists questioning whether the small clinical effects are economically worthwhile.

OBJECTIVE

To estimate the efficacy and safety of donepezil, galantamine, rivastigmine, and memantine for the treatment of AD.

METHODS

Double-blind, placebo-controlled, with random assignment to a cholinesterase inhibitor or memantine trials were included into the pooled studies.

RESULTS

Cognitive effects were significant for all drugs, ranging from a -1.29 points mean difference (95% CI -2.30 to -0.28) in the 20 mg daily memantine trials to -3.20 points (95% CI -3.28 to -3.12) in the 32 mg daily galantamine group. Only memantine had no effect on the Clinicians' Global Impression of Change scale. No behavioral benefits were observed, except for -2.72 (95% CI -4.92 to -0.52) in the 10 mg daily donepezil group and -1.72 (95% CI -3.12 to -0.33) for 24 mg daily galantamine trial. Only 5 mg daily donepezil had no effect on the function outcome. Compared with placebo, more dropouts and adverse events occurred with the cholinesterase inhibitors, but not with memantine.

CONCLUSIONS

Cholinesterase inhibitors and memantine are able to stabilize or slow decline in cognition, function, behavior, and global change.

Authors+Show Affiliations

Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China.Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Nanjing, China Department of Neurology, Qingdao Municipal Hospital, College of Medicine and Pharmaceutics, Ocean University of China, Qingdao, China.Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Nanjing, China.Department of Neurology, Qingdao Municipal Hospital, College of Medicine and Pharmaceutics, Ocean University of China, Qingdao, China.Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China.Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China.Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Nanjing, China.Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Nanjing, China.Department of Neurology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China Department of Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Nanjing, China Department of Neurology, Qingdao Municipal Hospital, College of Medicine and Pharmaceutics, Ocean University of China, Qingdao, China.

Pub Type(s)

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

Language

eng

PubMed ID

24662102

Citation

Tan, Chen-Chen, et al. "Efficacy and Safety of Donepezil, Galantamine, Rivastigmine, and Memantine for the Treatment of Alzheimer's Disease: a Systematic Review and Meta-analysis." Journal of Alzheimer's Disease : JAD, vol. 41, no. 2, 2014, pp. 615-31.
Tan CC, Yu JT, Wang HF, et al. Efficacy and safety of donepezil, galantamine, rivastigmine, and memantine for the treatment of Alzheimer's disease: a systematic review and meta-analysis. J Alzheimers Dis. 2014;41(2):615-31.
Tan, C. C., Yu, J. T., Wang, H. F., Tan, M. S., Meng, X. F., Wang, C., Jiang, T., Zhu, X. C., & Tan, L. (2014). Efficacy and safety of donepezil, galantamine, rivastigmine, and memantine for the treatment of Alzheimer's disease: a systematic review and meta-analysis. Journal of Alzheimer's Disease : JAD, 41(2), 615-31. https://doi.org/10.3233/JAD-132690
Tan CC, et al. Efficacy and Safety of Donepezil, Galantamine, Rivastigmine, and Memantine for the Treatment of Alzheimer's Disease: a Systematic Review and Meta-analysis. J Alzheimers Dis. 2014;41(2):615-31. PubMed PMID: 24662102.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy and safety of donepezil, galantamine, rivastigmine, and memantine for the treatment of Alzheimer's disease: a systematic review and meta-analysis. AU - Tan,Chen-Chen, AU - Yu,Jin-Tai, AU - Wang,Hui-Fu, AU - Tan,Meng-Shan, AU - Meng,Xiang-Fei, AU - Wang,Chong, AU - Jiang,Teng, AU - Zhu,Xi-Chen, AU - Tan,Lan, PY - 2014/3/26/entrez PY - 2014/3/26/pubmed PY - 2015/2/11/medline KW - Alzheimer's disease KW - donepezil KW - efficacy KW - galantamine KW - memantine KW - meta-analysis KW - rivastigmine KW - safety KW - systematic review SP - 615 EP - 31 JF - Journal of Alzheimer's disease : JAD JO - J. Alzheimers Dis. VL - 41 IS - 2 N2 - BACKGROUND: The role of currently available drugs for Alzheimer's disease (AD) has been controversial, with some national formularies restricting their use, and health economists questioning whether the small clinical effects are economically worthwhile. OBJECTIVE: To estimate the efficacy and safety of donepezil, galantamine, rivastigmine, and memantine for the treatment of AD. METHODS: Double-blind, placebo-controlled, with random assignment to a cholinesterase inhibitor or memantine trials were included into the pooled studies. RESULTS: Cognitive effects were significant for all drugs, ranging from a -1.29 points mean difference (95% CI -2.30 to -0.28) in the 20 mg daily memantine trials to -3.20 points (95% CI -3.28 to -3.12) in the 32 mg daily galantamine group. Only memantine had no effect on the Clinicians' Global Impression of Change scale. No behavioral benefits were observed, except for -2.72 (95% CI -4.92 to -0.52) in the 10 mg daily donepezil group and -1.72 (95% CI -3.12 to -0.33) for 24 mg daily galantamine trial. Only 5 mg daily donepezil had no effect on the function outcome. Compared with placebo, more dropouts and adverse events occurred with the cholinesterase inhibitors, but not with memantine. CONCLUSIONS: Cholinesterase inhibitors and memantine are able to stabilize or slow decline in cognition, function, behavior, and global change. SN - 1875-8908 UR - https://www.unboundmedicine.com/medline/citation/24662102/Efficacy_and_safety_of_donepezil_galantamine_rivastigmine_and_memantine_for_the_treatment_of_Alzheimer's_disease:_a_systematic_review_and_meta_analysis_ L2 - https://content.iospress.com/openurl?genre=article&id=doi:10.3233/JAD-132690 DB - PRIME DP - Unbound Medicine ER -