dc.contributor | Institut d'Assistència Sanitària |
dc.contributor.author | Saez, Marc |
dc.contributor.author | Barceló, Maria A. |
dc.contributor.author | Garre-Olmo, Josep |
dc.contributor.author | Vilalta-Franch, Joan |
dc.contributor.author | Capellà, Dolors |
dc.contributor.author | Castells, Xavier |
dc.contributor.author | Blanco-Silvente, Lídia |
dc.date.accessioned | 2021-12-02T12:06:53Z |
dc.date.available | 2021-12-02T12:06:53Z |
dc.date.issued | 2017-07 |
dc.identifier.citation | Blanco-Silvente L, Castells X, Saez M, Barceló MA, Garre-Olmo J, Vilalta-Franch J, et al. 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. Int J Neuropsychopharmacol. 2017 Jul;20(7):519-28. |
dc.identifier.issn | 1469-5111 |
dc.identifier.uri | https://hdl.handle.net/11351/6641 |
dc.description | Inhibidor de la colinesterasa; Malaltia d'Alzheimer; Metaanàlisi bayesiana |
dc.description.abstract | 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.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. 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). 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. |
dc.description.sponsorship | This work was supported by Universitat de Girona (grant nos. IFUdG2015/17, MPCUdG2016/ref50). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. |
dc.language.iso | eng |
dc.publisher | Cambridge University Press |
dc.publisher | Oxford University Press |
dc.relation.ispartofseries | International Journal of Neuropsychopharmacology;20(7) |
dc.rights | Attribution-NonCommercial-NoDerivatives 4.0 International |
dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0/ |
dc.source | Scientia |
dc.subject | Alzheimer, Malaltia d' |
dc.subject | Colinoesterases - Inhibidors |
dc.subject | Estadística bayesiana |
dc.subject.mesh | Alzheimer Disease |
dc.subject.mesh | Cholinesterase Inhibitors |
dc.subject.mesh | Bayes Theorem |
dc.title | 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 |
dc.type | info:eu-repo/semantics/article |
dc.identifier.doi | 10.1093/ijnp/pyx012 |
dc.subject.decs | enfermedad de Alzheimer |
dc.subject.decs | inhibidores de la colinesterasa |
dc.subject.decs | teorema de Bayes |
dc.relation.publishversion | https://doi.org/10.1093/ijnp/pyx012 |
dc.type.version | info:eu-repo/semantics/publishedVersion |
dc.audience | Professionals |
dc.event.productor | Biblioteca |
dc.contributor.authoraffiliation | [Blanco-Silvente L, Castells X, Garre-Olmo J, Vilalta-Franch J, Capellà D] Departament de Ciències Mèdiques, Universitat de Girona, Spain. [Saez M, Barceló MA] Grup de Recerca en Estadística, Econometria i Salut, Universitat de Girona, Spain. CIBER Epidemiologia y Salud Pública, Madrid, Spain. [Garre-Olmo J, Vilalta-Franch J] Institut d'Investigació Biomèdica de Girona (IdiBGi), Salt, Spain |
dc.identifier.pmid | 28201726 |
dc.rights.accessrights | info:eu-repo/semantics/openAccess |