Donepezil, rivastigmine, galantamine and memantine for ...

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78 Clinical effectiveness donepezil. Studies were of a short duration and it is therefore difficult to judge the long-term consequences. Furthermore, it is difficult to assess what the changes on these outcomes mean for people with AD and their carers, especially as there are no studies assessing QoL.
Anumber of systematic reviews of the cholinesterase inhibitors and memantine for AD were identified. In addition, literature reviews that did not use systematic methods were located but these will not be discussed further. Some of the systematic reviews identified did not use the same inclusion criteria as those set out for the current review. In particular, most did not impose any requirement for the severity of AD in the population. Some reviews, however, did share the same inclusion criteria of the current review and brief summaries are provided below. No formal data extraction or quality assessment of these systematic reviews was undertaken. Donepezil Two systematic reviews met the inclusion criteria. Wolfson and colleagues 74 This review did not include mild to moderate severity as an inclusion criterion. However, all studies reviewed included participants with mild to moderately severe AD and so it is presented here. This review also reports data for a number of other drugs including rivastigmine (see below), metrifonate and Ginkgo Biloba; however, the last two do not meet the inclusion criteria of the present review and are not discussed here. A subsequent publication based on this included review includes an updated search and includes an additional four donepezil studies. This publication, however, includes a trial that does not meet the inclusion criteria for the current review for this drug. Four studies were included in the review for donepezil, all of which are included in the present review. A summary of results is given here to provide a comparison for the results of the present review. The review reports that overall the trials are consistent in the finding that donepezil is a well-tolerated drug and has statistically significant effects both on cognition and the global clinical status of the participants over 12 and 24 weeks. The improvements as measured by the ADAS-cog were only slightly greater in the 10-mg treated participants than the 5-mg treated participants; however, there were more withdrawals from the high-dose group. Chapter 5 Health Technology Assessment 2006; Vol. 10: No. 1 Evidence from systematic reviews © Queen’s Printer and Controller of HMSO 2006. All rights reserved. Livingstone and Katona 75 Although the review did not include mild to moderate severity as an inclusion criterion, all studies reviewed included participants with mild to moderately severe AD and so it is presented here to provide a comparison for the results of the current review. This review also reports trials on rivastigmine (see below), tacrine and huperzine-A, the last two of which were not included in the current review. One study on donepezil met the inclusion criteria of the review and was also included in the current review. The review presents a number-needed-to-treat (NNT) analysis. The review concludes that higher doses of donepezil (10 mg) are associated with lower NNTs. One additional systematic review, by Birks and Harvey, 76 did not meet the inclusion criteria of the current review as participants were those with mild to moderate or severe dementia. This review was used as a source for references and as a comparator, as the included trials were also included in the current review. Rivastigmine Three systematic reviews met the inclusion criteria. Birks and colleagues 77 Although the review did not include mild to moderate severity as an inclusion criterion, all studies reviewed included participants with mild to moderately severe AD and so it is presented here to provide a comparison for the results of the current review. Seven studies met the inclusion criteria of the review, and all met the inclusion criteria for the present review. Meta-analyses were undertaken on the outcomes within the trial and a summary is presented here. Rivastigmine was shown to be beneficial on cognitive measures and activities of daily living measures. Four trials with doses of 6–12 mg/day showed improvement on the ADAS-cog score compared with placebo. In addition, response on the ADAS-cog (
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Health Technology Assessment 2006;
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The clinical and cost-effectiveness
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Objectives: To provide an update re
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List of abbreviations .............
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AChEI acetylcholinesterase inhibito
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Epidemiology and background Alzheim
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Galantamine Five published economic
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Description of underlying health pr
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TABLE 1 Estimated prevalence of AD
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as one component of their care. A n
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The a priori methods used for syste
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Data synthesis Data were synthesise
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14 Clinical effectiveness TABLE 3 C
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16 Clinical effectiveness TABLE 3 C
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18 Clinical effectiveness particula
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20 Clinical effectiveness Compariso
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22 Clinical effectiveness TABLE 6 M
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24 Clinical effectiveness donepezil
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26 Clinical effectiveness Compariso
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Page 48 and 49: 34 Clinical effectiveness clinical
Page 50 and 51: 36 Clinical effectiveness TABLE 10
Page 54 and 55: 40 Clinical effectiveness statistic
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Page 62 and 63: 48 Clinical effectiveness differenc
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Page 80 and 81: 66 Clinical effectiveness (24 mg/da
Page 84 and 85: 70 Clinical effectiveness ● One R
Page 86 and 87: 72 Clinical effectiveness by the pa
Page 94 and 95: 80 Evidence from systematic reviews
Page 96 and 97: 82 Economic analysis TABLE 48 Chara
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Page 100 and 101: 86 Economic analysis The UK study r
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Page 108 and 109: 94 Economic analysis Fenn and Gray
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Page 132 and 133: 118 Economic analysis Neumann and c
Page 134 and 135: 120 Economic analysis The model str
Page 136 and 137: 122 Economic analysis CEA, given th
Page 138 and 139: 124 Economic analysis TABLE 70 Key
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128 Economic analysis Probability o
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130 Economic analysis Results are s
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132 Economic analysis 4. The model
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134 Economic analysis perspective e
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136 Economic analysis indicating th
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Ongoing research, with relevance to
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The increasing numbers of the very
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146 Discussion and conclusions dose
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148 Discussion and conclusions effo
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150 Discussion and conclusions Stre
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1. Clegg A, Bryant J, Nicholson T,
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placebo-controlled study of donepez
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94. Brooks E, Deal L. The effect of
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of memantine in patients with moder
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This version of HTA monograph volum
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376 Health Technology Assessment Pr
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378 Health Technology Assessment Pr
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