Title:Comparative Efficacy and Acceptability of Cholinesterase Inhibitors and
Memantine Based on Dosage in Patients with Vascular Cognitive Impairment:
A Network Meta-analysis
Volume: 19
Issue: 2
Author(s): Xinxiu Shi, GuangHao Ren, Yang Cui and ZhongXin Xu*
Affiliation:
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China
Keywords:
Vascular cognitive impairment (VCI), vascular dementia (VD), cholinesterase inhibitors (ChEIs), memantine, network meta-analysis, placebo.
Abstract:
Background: Considering the lack of direct comparison between cholinesterase inhibitors
and memantine in patients with vascular cognitive impairment (VCI), determining how to choose the
best treatment plan remains inconclusive. Hence, we conducted the network meta-analysis to compare
the efficacy and acceptability of these drugs.
Methods: PubMed, the Cochrane Central Register of Controlled Trials, Embase and Web of Science
were searched for double-blind randomized controlled trials (RCTs) for the treatment of VCI, which
involved donepezil, galantamine, rivastigmine, and memantine, from database inception to January 1,
2020. Then, a network meta-analysis based on the frequency method was conducted.
Results: Eleven RCTs were included. Compared with the placebo, in terms of efficacy, donepezil 5
mg (standardized mean difference = -1.11, 95% confidence interval = -1.88 to -0.34), donepezil 10 mg
(-1.44, -2.31 to -0.56), galantamine 24 mg (-1.99, -3.03 to -0.95), and memantine 20 mg (-1.89, -2.93
to -0.86) were more effective for the cognition of ADAS-cog, and donepezil 5 mg (0.46, 0.12 to 0.81),
donepezil 10 mg (0.76, 0.34 to 1.17), and rivastigmine 12mg (0.60, 0.10 to 1.10) exhibited superior
benefits for the cognition of MMSE. Donepezil 10 mg (-0.25, -0.44 to -0.06; -1.47, -2.79 to -0.15) exhibited
improvements for CDR-SB and EXIT25, respectively. In terms of acceptability, memantine
was found to be the best.
Conclusion: Donepezil 5 mg, donepezil 10 mg, galantamine 24 mg, memantine 20 mg, and rivastigmine
12 mg exerted beneficial effects on cognition, and donepezil 10mg provided beneficial effects for executive
function and global status. Based on the network meta-analysis, donepezil 10 mg might be the best
choice, considering the benefits on cognition function, executive function and global status, but doserelated
adverse reactions need to be noted. In the meantime, memantine is a better comprehensive choice
in terms of efficacy and safety.
