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To Treat Alzheimer Disease, 2 Drugs May Be Better Than 1
11/9/2016 9:35:00 AM
Information sourced from NEJM Journal Watch:
To Treat Alzheimer Disease, Two Drugs May Be Better Than One
Combining donepezil and memantine seems to have moderately better results than donepezil alone.
Patients, families, and clinicians eager to delay or reverse cognitive and related impairments associated with Alzheimer disease have often administered the cholinesterase inhibitor donepezil or the NMDA receptor antagonist memantine, despite their relatively meager benefits. In this first-ever meta-analysis of studies examining the concurrent use of these medications, investigators compared the combination of memantine and donepezil with donepezil monotherapy for moderate-to-severe Alzheimer disease.
Eleven studies were included, involving a total of 848 patients and typically prescribing medications for 24 weeks (range, 12–52 weeks). Dosages ranged from 5 to 10 mg/day for donepezil and 5 to 20 mg/day for memantine and were in many cases increased incrementally. Combination treatment showed better results than monotherapy for improvement in cognitive function, behavioral and psychological symptoms, and global functioning; overall effect sizes were moderate to large. Safety and adverse drug reactions did not differ significantly between the combination and monotherapy groups.
COMMENT
Study heterogeneity was considerable, consistent with these medications’ different mechanisms of action. Nevertheless, this meta-analysis suggests that combining donepezil and memantine results in greater improvements in cognition, behavior, and psychological symptoms for patients with moderate-to-severe Alzheimer disorder. Reassuringly, the findings also show that the combination does not increase adverse effects. Although overall improvement may still be modest, stakeholders might judge the potential benefits of pursuing combined treatment to be worth the expense.
Joel Yager, MD reviewing Chen R et al. PLoS One 2017 Aug 21.
CITATION(S):
Chen R et al. Treatment effects between monotherapy of donepezil versus combination with memantine for Alzheimer disease: A meta-analysis. PLoS One 2017 Aug 21; 12:e0183586.
[Free full-text PLoS One article]
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