An open-label, comparative study of rivastigmine, donepezil and galantamine in a real-world setting

被引:43
作者
Aguglia, E [1 ]
Onor, ML [1 ]
Saina, M [1 ]
Maso, E [1 ]
机构
[1] Univ Trieste, UCO Clin Psychiat, Dept Clin Morphol & Technol Sci, Alzheimer Dis & Other Dementias Unit, I-34100 Trieste, Italy
关键词
Alzheimer disease; clinical trial; donepezil; galantamine; rivastigmine;
D O I
10.1185/030079904X6273
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective:We analysed the effects of donepezil, rivastigmine and galantamine, prescribed for the treatment of Alzheimer disease in a real-world setting in Italy. Methods: Outcome measures included the Mini-Mental State Examination (MMSE), the Alzheimer Disease Assessment Scale cognitive subscale (ADAS-cog), Instrumental Activity of Daily Living (IADL) and ADL scales. Results: Seventy patients were treated with donepezil, 121 with rivastigmine and 51 with galantamine. At 6 months, rivastigmine-treated patients improved by 1.29 points from baseline on the ADAS-cog, while donepezil- and galantamine-treated patients showed 'no change' (changes of < 0.2 points). On the IADL, patients treated with rivastigmine, donepezil and galantamine showed decreases of 0.42, 0.58 and 0.75 points, respectively. On the ADL, donepezil- and galantamine-treated patients showed decreases of 0.44 and 0.86 points, respectively, while there was. no change' with rivastigmine. On the MMSE, donepezil- and rivastigmine-treated patients showed 'no change' and galantamine-treated patients showed a mean decrease of 1.19 points. A subgroup analysis of 'pseudo-randomised' patients (rivastigmine, n = 63; donepezil, n = 55; galantamine, n = 51) supported the main findings. Side effects were similar (in type and frequency) in the three treatment groups. Conclusions: This is the first study to compare the effects of the three most commonly-used cholinesterase inhibitors on the MMSE, ADAS-cog, IADL and ADL. Limitations included its small population size, its open-label design, and the fact that patients were randomised only after the introduction of galantamine. There were no statistically significant differences between the three drugs at 3 months. While numerical trends were observed suggesting the effect of rivastigmine > donepezil > galantamine, larger, longer-term prospective studies are needed to confirm whether there are important differences in the long-term efficacy of the three drugs.
引用
收藏
页码:1747 / 1752
页数:6
相关论文
共 19 条
[1]   Advances in the treatment of Alzheimer's disease: Benefits of dual cholinesterase inhibition [J].
Ballard, CG .
EUROPEAN NEUROLOGY, 2002, 47 (01) :64-70
[2]  
Clegg A, 2001, Health Technol Assess, V5, P1
[3]  
D'Agostino RB, 1998, STAT MED, V17, P2265, DOI 10.1002/(SICI)1097-0258(19981015)17:19<2265::AID-SIM918>3.0.CO
[4]  
2-B
[5]  
DAVIES P, 1976, LANCET, V2, P1403
[6]   Practice parameter: Management of dementia (an evidence-based review) - Report of the Quality Standards Subcommittee of the American Academy of Neurology [J].
Doody, RS ;
Stevens, JC ;
Beck, C ;
Dubinsky, RM ;
Kaye, JA ;
Gwyther, L ;
Mohs, RC ;
Thal, LJ ;
Whitehouse, PJ ;
DeKosky, ST ;
Cummings, JL .
NEUROLOGY, 2001, 56 (09) :1154-1166
[7]   MINI-MENTAL STATE - PRACTICAL METHOD FOR GRADING COGNITIVE STATE OF PATIENTS FOR CLINICIAN [J].
FOLSTEIN, MF ;
FOLSTEIN, SE ;
MCHUGH, PR .
JOURNAL OF PSYCHIATRIC RESEARCH, 1975, 12 (03) :189-198
[8]  
Greig NH, 2001, CURR MED RES OPIN, V17, P159
[9]   STUDIES OF ILLNESS IN THE AGED - THE INDEX OF ADL - A STANDARDIZED MEASURE OF BIOLOGICAL AND PSYCHOSOCIAL FUNCTION [J].
KATZ, S ;
FORD, AB ;
MOSKOWITZ, RW ;
JACKSON, BA ;
JAFFE, MW .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1963, 185 (12) :914-919
[10]   ASSESSMENT OF OLDER PEOPLE - SELF-MAINTAINING AND INSTRUMENTAL ACTIVITIES OF DAILY LIVING [J].
LAWTON, MP ;
BRODY, EM .
GERONTOLOGIST, 1969, 9 (3P1) :179-&