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Identification of the optimal cognitive drugs among Alzheimer’s disease: a Bayesian meta-analytic review

Authors Liang JH, Li JY, Jia RX, Wang YQ, Wu RK, Zhang HB, Hang L, Xu Y

Received 22 August 2018

Accepted for publication 22 September 2018

Published 18 October 2018 Volume 2018:13 Pages 2061—2073

DOI https://doi.org/10.2147/CIA.S184968

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Andrew Yee

Peer reviewer comments 2

Editor who approved publication: Dr Zhi-Ying Wu


Jinghong Liang, Jiayu Li, Ruixia Jia, Yingquan Wang, Rongkun Wu, Hongbo Zhang, Lei Hang, Yong Xu

Department of Child Health, Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, School of Public Health, Soochow University, Suzhou, China

Purpose:
The increasing prevalence of Alzheimer’s disease (AD) demands more effective drugs, which are still unclear. The aim of this study is to compare the effectiveness of six drugs, such as donepezil, rivastigmine, galantamine, memantine, huperzine-A, and tacrine, in senior AD patients and identify the most effective one to improve patients’ cognitive function.
Methods: A system of search strategies was used to identify relevant studies including randomized controlled trials and clinical controlled trials evaluating the efficacy of six drugs in patients with AD. We updated relevant studies that were published before March 2018 as full-text articles. Using Bayesian network meta-analysis (NMA), we ranked cognitive ability objectively based on Mini–Mental State Examination (MMSE). Pairwise and NMAs were sequentially performed for the efficacy of drugs compared to each drug or control group through the trials included.
Results: Among the 35 trials included, no obvious heterogeneity (I2=0.0%, P=0.583) was revealed according to the pooled data for cognition in NMA and the mean difference (MD) of memantine (MD=1.7, 95% CI: 0.73, 2.8) showed that the memantine was significantly efficacious in the treatment group in terms of MMSE. Followed by galantamine, huperzine-A, rivastigmine, tacrine, and donepezil.
Conclusion: As the first NMA comparing the major drugs in market for AD, our study suggests that memantine might have a more significant benefit on cognition than other five drugs available.

Keywords: Alzheimer’s disease, cognitive drugs, Bayesian network meta-analysis

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