Donepezil, rivastigmine, galantamine and memantine for ...

Review:
Comparison:
Outcome:
01 6 months
Raskind 2000 gal
Tariot 2000 gal
Wilcock 2000 gal
Subtotal (95% CI)
202
253
220
675
–1.96 (5.10)
–1.40 (6.20)
–0.50 (5.60)
Test for heterogeneity 2 = 1.96, df = 2 (p = 0.38), p = 0
Test for overall effect z = 10.20, p < 0.00001
02 3 months
Wilkinson 2001 gal
Subtotal (95% CI)
Alzheimer 2003
07 Galantamine ADAS-Cog change from baseline
01 Galantamine 24
Study
or sub-category n
55
55
Test for heterogeneity not applicable
Test for overall effect z = 2.63, p = 0.009
Treatment
Mean (SD) n
207
255
215
677
–1.40 (6.70) 82
82
In a comparison of three doses of galantamine
with placebo over a 3-month period, Wilkinson
and Murray 65 found that participants receiving
either 18 mg/day (difference 1.7 points),
24 mg/day (difference 3.0 points) or 36 mg/day
(difference 2.3 points) galantamine experienced
an improvement on the ADAS-cog scale, whereas
those on placebo deteriorated. Only participants
receiving 24 mg/day galantamine improved
statistically significantly compared with placebo.
Control
Mean (SD)
2.00 (6.50)
1.70 (6.20)
2.40 (6.00)
© Queen’s Printer and Controller of HMSO 2006. All rights reserved.
Health Technology Assessment 2006; Vol. 10: No. 1
WMD
(95% CI fixed)
Weight
%
29.16
32.07
31.31
92.54
1.60 (6.30) 7.46
7.46
WMD
(95% CI fixed)
–3.96 (–5.09 to –2.83)
–3.10 (–4.18 to –2.02)
–2.90 (–3.99 to –1.81)
–3.30 (–3.94 to –2.67)
–3.00 (–5.23 to –0.77)
–3.00 (–5.23 to –0.77)
Total (95% CI)
Test for heterogeneity 2 730
759 100.0 –3.28 (–3.89 to –2.67)
= 2.02, df = 3 (p = 0.57), p = 0
Test for overall effect z = 10.53, p < 0.00001
FIGURE 13 ADAS-cog change from baseline with galantamine 24 mg
Comparison:
Outcome:
Study
Rockwood 2001 gal
Wilkinson 2001 gal
07 Galantamine ADAS-cog change from baseline
03 Galantamine 24–32
Treatment
n
260
239
Mean
(SD)
–0.90 (5.00)
–1.10 (5.10)
Total (95% CI)
Test for heterogeneity 2 499
= 0.02, df = 1, p = 0.9
Test for overall effect z = 4.16, p = 0.00003
Control
n
125
120
–10 –5 0 5 10
Favours treatment Favours control
Mean
(SD)
0.70 (5.30)
0.60 (4.90)
FIGURE 14 ADAS-cog change from baseline with galantamine 24–32 mg
WMD
(95% CI fixed)
Weight
%
49.1
50.9
–1.60 (–2.71 to –0.49)
–1.70 (–2.79 to –0.61)
245 100.0 –1.65 (–2.43 to –0.87)
–10 –5 0 5 10
Favours treatment Favours control
WMD
(95% CI fixed)
The benefits of treatment with galantamine
compared with placebo on the ADAS-cog scale
were shown through meta-analyses, using fixed
and random effects models, for different doses
and lengths of study. The fixed-effect model for
24 mg/day galantamine compared with placebo
showed a weighted mean difference on ADAS-cog
favouring galantamine at 3 months [WMD –3.00
(95% CI: –5.23 to –0.77)] and 6 months follow-up
[WMD –3.28 (95% CI: –3.89 to –2.67)] (see
57