2026-04-17T06:37:01Zhttps://recercat.cat/oai/request

oai:recercat.cat:10256/141452024-05-21T10:36:29Zcom_2072_452955com_2072_2054col_2072_452960

Discontinuation, Efficacy, and Safety of Cholinesterase Inhibitors for Alzheimer’s Disease: a Meta-Analysis and Meta-Regression of 43 Randomized Clinical Trials Enrolling 16.106 Patients Blanco Silvente, Lídia Castells Cervelló, Xavier Sáez Zafra, Marc Barceló Rado, María Antonia Garre Olmo, Josep Vilalta Franch, Joan Capellà Hereu, Dolors Alzheimer, Malaltia d' Alzheimer's disease Assaigs clínics Clinical trials We investigated the effect of cholinesterase inhibitors on all-cause discontinuation, efficacy and safety, and the effects of study design-, intervention-, and patient-related covariates on the risk-benefit of cholinesterase inhibitors for Alzheimer’s disease. Methods: A systematic review and meta-analysis of randomized placebo-controlled clinical trials comparing cholinesterase inhibitors and placebo was performed. The effect of covariates on study outcomes was analysed by means of meta-regression using a Bayesian framework. Results: Forty-three randomized placebo-controlled clinical trials involving 16106 patients were included. All-cause discontinuation was higher with cholinesterase inhibitors (OR = 1.66), as was discontinuation due to adverse events (OR=1.75). Cholinesterase inhibitors improved cognitive function (standardized mean difference = 0.38), global symptomatology (standardized mean difference=0.28) and functional capacity (standardized mean difference=0.16) but not neuropsychiatric symptoms. Rivastigmine was associated with a poorer outcome on all-cause discontinuation (Diff OR = 1.66) and donepezil with a higher efficacy on global change (Diff standardized mean difference = 0.41). The proportion of patients with serious adverse events decreased with age (Diff OR = -0.09). Mortality was lower with cholinesterase inhibitors than with placebo (OR = 0.65). Conclusion: While cholinesterase inhibitors show a poor risk-benefit relationship as indicated by mild symptom improvement and a higher than placebo all-cause discontinuation, a reduction of mortality was suggested. Intervention- and patient-related factors modify the effect of cholinesterase inhibitors in patients with Alzheimer’s disease 2024-05-21T10:36:29Z 2024-05-21T10:36:29Z 2024-05-21T10:36:29Z 2017-02-13 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion http://hdl.handle.net/10256/14145 info:eu-repo/semantics/altIdentifier/doi/10.1093/ijnp/pyx012 info:eu-repo/semantics/altIdentifier/issn/1461-1457 info:eu-repo/semantics/altIdentifier/eissn/1469-5111 Attribution-NonCommercial 3.0 Spain http://creativecommons.org/licenses/by-nc/3.0/es/ info:eu-repo/semantics/openAccess Oxford University Press (OUP) International Journal of Neuropsychopharmacology, 2017, vol 20, núm. 7, p. 519-528 Articles publicats (D-CM)