Efficacy and safety of donepezil, galantamine, rivastigmine, and memantine for
the treatment of Alzheimer's disease: a systematic review and meta-analysis.
Author(s): Tan CC(1), Yu JT(2), Wang HF(3), Tan MS(4), Meng XF(1), Wang C(1), Jiang T(3),
Zhu XC(3), Tan L(2).
Affiliation(s): Author information:
(1)Department of Neurology, Qingdao Municipal Hospital, School of Medicine,
Qingdao University, Qingdao, China. (2)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. (3)Department of
Neurology, Qingdao Municipal Hospital, Nanjing Medical University, Nanjing,
China. (4)Department of Neurology, Qingdao Municipal Hospital, College of
Medicine and Pharmaceutics, Ocean University of China, Qingdao, China.
Publication date & source: 2014, J Alzheimers Dis. , 41(2):615-31
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.
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