Systematic Review and Meta-Analysis of Combination Therapy with Cholinesterase Inhibitors and Memantine in Alzheimer's Disease and Other Dementias
Identifieur interne : 001121 ( Main/Exploration ); précédent : 001120; suivant : 001122Systematic Review and Meta-Analysis of Combination Therapy with Cholinesterase Inhibitors and Memantine in Alzheimer's Disease and Other Dementias
Auteurs : Taim Muayqil [Arabie saoudite] ; Richard Camicioli [Canada]Source :
- Dementia and Geriatric Cognitive Disorders EXTRA [ 1664-5464 ] ; 2012.
Abstract
To determine the efficacy and safety of using combination therapy with memantine and a ChEI to treat dementia in comparison to monotherapy with either memantine or a ChEI.
In March 2012, we systematically searched MEDLINE/PubMed, EMBASE, Cochrane library, and grey literature databases. All study types were included, except for case series or reports, which looked at combination therapy versus monotherapy in various dementing disorders. Data was pooled for blinded randomized controlled trials (RCTs) only; mean differences and standardized mean differences were used to determine effect sizes.
Thirteen studies were included in this review; 3 were blinded RCTs, with a total of 971 Alzheimer's disease (AD) patients, which were included into the meta-analysis. No papers were found that primarily addressed combination therapy in other dementias. In the meta-analysis, small but statistically significant effect sizes were seen in favor of combination therapy among patients with moderate to severe AD on the scales of cognition (0.45–0.52; p < 0.0001), scales of functional outcomes (0.23–0.3; p < 0.01), and the neuropsychiatric inventory (3.7–4.4; p < 0.0001). Among the open-label studies, 3 out of 6 suggested benefits, as did the 4 included cohort studies. However, the high risk of bias encountered in the latter two study designs limits deducing any conclusions about benefit.
Although there were statistically significant changes in favor of combination therapy in moderate to severe AD, heterogeneity in scales and patient characteristics exists. However, it is unclear if clinically significant outcomes can be achieved using the combination therapy. More studies are required before a recommendation for combination therapy can be made.
Url:
DOI: 10.1159/000343479
PubMed: 23277787
PubMed Central: 3522458
Affiliations:
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Le document en format XML
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Systematic Review and Meta-Analysis of Combination Therapy with Cholinesterase Inhibitors and Memantine in Alzheimer's Disease and Other Dementias</title>
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<country xml:lang="fr">Arabie saoudite</country>
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<author><name sortKey="Camicioli, Richard" sort="Camicioli, Richard" uniqKey="Camicioli R" first="Richard" last="Camicioli">Richard Camicioli</name>
<affiliation wicri:level="1"><nlm:aff id="aff2">Division of Neurology, University of Alberta, Edmonton, Alb., Canada</nlm:aff>
<country xml:lang="fr">Canada</country>
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<series><title level="j">Dementia and Geriatric Cognitive Disorders EXTRA</title>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p><italic>N</italic>
-methyl-D-aspartic acid antagonists (memantine) and cholinesterase inhibitors (ChEIs) are the only two approved classes of drugs to treat dementia; this paper explores the evidence for using these two treatments in combination.</p>
</sec>
<sec><title>Objective</title>
<p>To determine the efficacy and safety of using combination therapy with memantine and a ChEI to treat dementia in comparison to monotherapy with either memantine or a ChEI.</p>
</sec>
<sec><title>Methods</title>
<p>In March 2012, we systematically searched MEDLINE/PubMed, EMBASE, Cochrane library, and grey literature databases. All study types were included, except for case series or reports, which looked at combination therapy versus monotherapy in various dementing disorders. Data was pooled for blinded randomized controlled trials (RCTs) only; mean differences and standardized mean differences were used to determine effect sizes.</p>
</sec>
<sec><title>Results</title>
<p>Thirteen studies were included in this review; 3 were blinded RCTs, with a total of 971 Alzheimer's disease (AD) patients, which were included into the meta-analysis. No papers were found that primarily addressed combination therapy in other dementias. In the meta-analysis, small but statistically significant effect sizes were seen in favor of combination therapy among patients with moderate to severe AD on the scales of cognition (0.45–0.52; p < 0.0001), scales of functional outcomes (0.23–0.3; p < 0.01), and the neuropsychiatric inventory (3.7–4.4; p < 0.0001). Among the open-label studies, 3 out of 6 suggested benefits, as did the 4 included cohort studies. However, the high risk of bias encountered in the latter two study designs limits deducing any conclusions about benefit.</p>
</sec>
<sec><title>Conclusion</title>
<p>Although there were statistically significant changes in favor of combination therapy in moderate to severe AD, heterogeneity in scales and patient characteristics exists. However, it is unclear if clinically significant outcomes can be achieved using the combination therapy. More studies are required before a recommendation for combination therapy can be made.</p>
</sec>
</div>
</front>
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</TEI>
<affiliations><list><country><li>Arabie saoudite</li>
<li>Canada</li>
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<tree><country name="Arabie saoudite"><noRegion><name sortKey="Muayqil, Taim" sort="Muayqil, Taim" uniqKey="Muayqil T" first="Taim" last="Muayqil">Taim Muayqil</name>
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