Special ArticleMetaanalysis of Randomized Trials of the Efficacy and Safety of Donepezil, Galantamine, and Rivastigmine for the Treatment of Alzheimer Disease
Section snippets
Literature Review
There were five stages of searching: electronic searching of databases, direct contact with pharmaceutical companies, manual reviews of key journals and conference proceedings, manual searching of references in papers identified from electronic searching, and direct contact with authors by e-mail.
We searched MEDLINE; EMBASE; PsycINFO; the Cochrane Library Database (including the Cochrane Controlled Trials Register); International Pharmaceutical Abstracts; SIGLE (System for Information on Grey
RESULTS
Results of the literature search and the metaanalysis are presented separately.
DISCUSSION
The literature review proved effective. All of the papers used by the Cochrane Dementia Group in their metaanalyses were identified by our search strategy, although four articles were included in this study that were not in the Cochrane review.21, 22, 23, 29 The first three of these extra papers involved severe or nursing home-resident AD patients, and the final paper had also included subjects with vascular dementia.
The decision to not extract data for behavioral or neuropsychiatric efficacy
CONCLUSIONS
The aim of this study was, through a systematic review of the literature and metaanalysis, to describe the respective efficacy and safety of each of the three most commonly prescribed drugs in Alzheimer disease.
In essence, there is little to choose from in efficacy between donepezil and rivastigmine at high doses and galantamine at all doses in terms of change from baseline in the ADAS–Cog scale. It is interesting to note that our regression analysis demonstrated comparable efficacy across the
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We thank Chris Frost at the London School of Hygiene and Tropical Medicine for his advice on regression techniques in metaanalysis.
Dr. Ritchie is funded by a Health Services Research Fellowship Grant from the UK Medical Research Council. Dr. Ames has received consultancy fees, speaker's honoraria, and financial support to attend conferences from Pfizer/Eisai, Novartis, and Janssen-Cilag.
Shire Pharmaceutical, Pfizer-Eisai, and Novartis all provided manuscripts and abstracts as part of the systematic review.
Note: The following articles, cited below, were used in the metaanalysis: References 11 and 13–31.