Comparative safety and effectiveness of cholinesterase inhibitors and memantine for Alzheimer's disease: a network meta-analysis of 41 randomized controlled trials.
BACKGROUND
Cholinesterase inhibitors and memantine have been approved for management of Alzheimer's disease (AD), but there has been no consensus about the choice of various types and doses of drugs at different stages. Hence, we compared and ranked the efficacy and tolerability of these available drugs.


METHODS
We searched PubMed, the Cochrane Central Register of Controlled Trials, and Embase for randomized controlled trials (RCTs) published from database inception to July 21, 2017. The primary outcomes were the mean overall changes in cognitive function and responders who had any adverse events. We conducted a random-effects network meta-analysis.


RESULTS
Forty-one RCTs were included in this study. Compared with placebo, galantamine 32 mg daily (standardized mean difference - 0.51, 95% credible interval - 0.67 to - 0.35), galantamine 24 mg daily (- 0.50, - 0.61 to - 0.40), and donepezil 10 mg daily (- 0.40, - 0.51 to - 0.29) were probably the most effective agents on cognition for mild to moderate AD, and memantine 20 mg combined with donepezil 10 mg (0.76, 0.39 to 1.11) was recommended for moderate to severe patients. Memantine showed the best profile of acceptability. Rivastigmine transdermal 15-cm2 patch was the best optional treatment both in function and global changes. None of the medicines was likely to improve neuropsychiatric symptoms through this analysis.


CONCLUSIONS
Pharmacological interventions have beneficial effects on cognition, function, and global changes, but not on neuropsychiatric symptoms, through current network meta-analysis. The choice of drugs may mainly depend on the disease severity and clinical symptoms.
['Dou|Kai-Xin|KX|', 'Tan|Meng-Shan|MS|', 'Tan|Chen-Chen|CC|', 'Cao|Xi-Peng|XP|', 'Hou|Xiao-He|XH|', 'Guo|Qi-Hao|QH|', 'Tan|Lan|L|', 'Mok|Vincent|V|', 'Yu|Jin-Tai|JT|']
D000544:Alzheimer Disease D002800:Cholinesterase Inhibitors D005260:Female D006801:Humans D008297:Male D008559:Memantine D000071076:Network Meta-Analysis D018697:Nootropic Agents D016032:Randomized Controlled Trials as Topic D016896:Treatment Outcome
Cholinesterase inhibitors Memantine Network meta-analysis Alzheimer’s disease