In this Therapeutics Letter we summarize currently available evidence on the three acetylcholinesterase inhibitors licensed for treatment of Alzheimer disease in Canada: donepezil (Aricept), rivastigmine (Exelon), and galantamine (Reminyl), as well as the neuroreceptor antagonist, memantine (Ebixa).
We conclude that:
donepezil has not been shown to improve outcomes of importance to patients and caregivers (eg, reducing institutionalization or disability);
rivastigmine and galantamine have not been studied for these outcomes;
acetylcholinesterase inhibitors cause gastrointestinal, muscular, and other adverse effects and likely cause an increase in serious adverse events;
no evidence indicates that stopping acetylcholinesterase inhibitors treatment is harmful; and
in patients with advanced Alzheimer disease, memantine has not been shown to improve outcomes of importance to patients and caregivers.
Source: Therapeutics Letter 2005;56:1-4.
For the complete text of this report, check the Therapeutics Initiative website http://www.ti.ubc.ca.
The Therapeutics Letter presents critically appraised summary evidence primarily from controlled drug trials. Such evidence applies to patients similar to those involved in the trials and might not be generalizable to every patient. The Therapeutics Initiative provides evidence-based advice about drug therapy and is not responsible for formulating or adjudicating provincial drug policies. Website: http://www.ti.ubc.ca