Patients with mild-to-moderate-Alzheimer’s disease receiving monotherapy with acetylcholinesterase inhibitors reported cognitive and physical improvements compared with those receiving a combination of memantine and acetylcholinesterase inhibitors, according to a meta-analysis presented at the Alzheimer’s Association International Conference.
“Combination therapy with memantine and [acetylcholinesterase inhibitors] was proposed for patients with moderate-to-severe Alzheimer’s disease, but the additional benefits of combination therapy over monotherapy is still controversial,” Kelvin Tsoi, PhD, of The Chinese University of Hong Kong, and colleagues wrote.
Researchers reviewed 76 randomized-controlled trials consisting of 23,707 patients from more than 30 countries, looking for post-intervention changes of donepezil, galantamine, memantine, placebo and rivastigmine use vs. a combination of acetylcholinesterase inhibitors and memantine.
Tsoi and colleagues found that for patients with mild-to-moderate Alzheimer’s disease, rivastigmine users showed better cognitive performance on the Mini-Mental State Examination than those who used combination therapy (mean difference = 0.83; 95% CrI, 0.07-1.58). Donepezil users had greater improvement in Alzheimer’s Disease Cooperative Study–Activities of Daily Living scores vs. patients receiving combination therapy (mean difference = 3.62; 95% CrI, 1.25-6). Galantamine users had a mean difference of 2.87 (95% CrI, 0.96-4.87) on that same activity score vs. those receiving combination therapy.
"There is a need to review the current guidelines on the use of combination therapy for people with [Alzheimer’s disease]," Tsoi and colleagues concluded. – by Janel Miller
Tsoi K, et al. Combination therapy showed no additional benefit over monotherapy for Alzheimer’s disease: A network meta-analysis of 76 randomized controlled trials.
Presented at: Alzheimer’s Association International Conference; July 22-26, 2018; Chicago.
Disclosure: Healio Family Medicine was unable to determine the authors’ relevant financial disclosures prior to publication.