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Week of March 16 - March 22, 2008
An American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) committee just issued a new guideline on drug treatment of dementia. Their advice? When trying to decide which medicine isbest for a person, the most important considerations are:
- Side effects
- Ease of Use
- Cost
There's no proof that any one of the five drugs available in the United States to treat dementia in general, and Alzheimer's in particular, is more effective than the others.
The committee reviewed published studies for outcomes such as cognition, global function, behavior/mood, and quality of life/activities of daily living. They found only limited high-quality scientific evidence of the effectiveness of the drugs and therefore developed the following cautious recommendations:
- The decision to use approved drugs for dementia should be based on an individualized patient assessment.
- The choice of drugs should be based on tolerability, adverse effect profile, ease of use, and cost.
- There's an urgent need for more clinical research to improve knowledge about the clinical effectiveness of drugs used to treat dementia.
The committee recommended the following kinds of research:
- Evaluate the effectiveness of drug therapy for dementia and assess whether treatments affect key outcomes, such as institutionalization.
- Evaluate the appropriate duration of therapy.
- Head-to-head testing of drugs.
- Test drugs in combination therapy.
The guideline was just published in the Annals of Internal Medicine.
Currently, there are five FDA-approved drugs for treatment of dementia. These include four acetylcholinesterase inhibitors - donepezil (Aricept), galantamine (Razadyne, Reminyl), rivastigmine (Exelon), and tacrine - and one neuropeptide-modifying agent - memantine (Namenda).
While these drugs may improve symptoms or slow disease progression, they don't cure dementia or repair brain damage.
"Doctors, patients and family caregivers desperately want information on how to treat this disease," Dr. Amir Qaseem, senior medical associate in the ACP's Clinical Programs and Quality of Care Department, said in a prepared statement.
"More research is warranted, because the available evidence concerning these pharmaceuticals' effects on quality of life is mixed, and the clinical significance of many of the findings is questionable," Dr. Kenneth G. Schellhase, an AAFP representative on the committee, said in a prepared statement. "In addition, the duration of existing trials was usually less than one year, providing insufficient information to determine the optimal length of treatment, and few trials compare one drug directly with another."
Most existing studies of the five approved dementia drugs focused on statistical significance of changes, but clinically important improvement is what matters to patients, caregivers and doctors, the committee noted. Many studies measuring clinical improvements are currently in progress throughout the world.
More Information:
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Source:
Effectiveness of Cholinesterase Inhibitors and Memantine for Treating Dementia: Evidence Review for a Clinical Practice Guideline,
Annals of Internal Medicine, March 2008
Byline:
By Robert Preidt, Healthday News
Reviewed for medical accuracy by
Dr. Boaz Ancselovic, MD, Geriatrician, Alzheimer's Weekly
Copyright:
Copyright © 2008 ScoutNews, LLC. All rights reserved.
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