Donepezil, rivastigmine, galantamine and memantine for ...

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Clinical effectiveness
placebo [OR 1.43 (95% CI: 0.98 to 2.08)]
favoured galantamine at 6 months follow-up.
Use of the random effects models resulted in
limited change to the outcomes of the metaanalysis
and none of the models were affected by
heterogeneity.
Summary: in individual studies higher proportions of
participants on galantamine improved on CIBIC-plus
and CGIC compared with participants on placebo, who
were likely to deteriorate. When studies were pooled, no
statistical significance is noted between treatment groups
and placebo.
Function
DAD
Three RCTs assessed changes from baseline on the
DAD scale (Table 29). 62,64,66 The DAD scale
assesses basic and instrumental activities of daily
living, initiation, planning and organisation,
performance and leisure, scoring people between
0 and 100. Rockwood and colleagues 62 noted that
participants in the 24–32 mg/day galantamine
group deteriorated statistically significantly less
than those in the placebo group (difference
4.1 points). Similarly, Wilkinson and colleagues 66
reported a statistically significantly smaller
deterioration on the DAD scale for participants in
the 24–32 mg/day galantamine group compared
with placebo (difference 4.8 points). Wilcock and
colleagues 64 noted a slower deterioration in DAD
scores for participants receiving 24 mg/day
(difference 2.8 points) or 32 mg/day (difference
3.5 points) galantamine compared with placebo,
statistically significantly so for the group receiving
32 mg/day.
TABLE 29 DAD for galantamine: all mean (SEM) change from baseline
Rockwood et al. 62
ADL
Tariot and colleagues 63 reported mean (SEM)
changes from baseline on the Alzheimer’s Disease
Cooperative Study Activities of Daily Living
inventory (ADCS/ADL) for participants receiving
8, 16 and 24 mg/day galantamine and placebo.
This outcome measure assesses daily activities in
participants, such as using household appliances,
choosing clothes to wear, bathing and toileting.
Although all participants had deteriorated over
the 5 months’ duration of the study, it was
statistically significantly less for those receiving
16 mg/day [–0.7 (SEM 0.5), p < 0.001] and
24 mg/day [–1.5 (SEM 0.6), p < 0.01] than
placebo [–3.8 (SEM 0.6)]. [Commercial/academic
confidential information removed]
PDS
Wilkinson and Murray 65 assessed differences in
the proportion of participants who were classified
as either much improved, improved, no change,
worse or much worse on the PDS-1, which is a
measure of activities of daily living. Although
participants receiving either 18, 24 or 36 mg/day
galantamine were less likely to be worse/much
worse compared with participants on placebo and
that participants receiving either 18 or 24 mg/day
were more likely to have improved/much improved
compared with participants on placebo or
36 mg/day galantamine, the differences were not
statistically significant.
Summary: participants receiving galantamine appeared
to suffer less deterioration compared with those on
placebo, statistically significantly for doses between 16
and 32 mg/day on the DAD and ADL scales.
Galantamine 24–32 mg/day (n = 261) Placebo (n = 125) p-Value vs placebo
–1.2 (0.83) –5.3 (1.17) p < 0.01
Wilkinson et al. 66
Galantamine 24–32 mg/day (n = 239) Placebo (n = 120) p-Value vs placebo
–0.4 (0.76) –5.2 (1.18) p < 0.001
Wilcock et al. 64
1. Galantamine 24 mg/day 2. Galantamine 3. Placebo (n = 210) Treatment difference
(n = 212) 32 mg/day (n = 214) (95% CI), p-value vs
placebo
–3.2 (1.02) –2.5 (1.07) –6.0 (1.08) 1. 2.8 (–0.6 to 6.1)
p = 0.1
2. 3.4 (0.1 to 6.7)
p < 0.05