Hui Ma1, Yinglin Huang2, Zhengtu Cong3, Yuan Wang3, Wenhai Jiang4, Shuhe Gao4, Gang Zhu3. 1. Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China Center for Mental Health, Yanshan University, Qinhuangdao, China. 2. Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China Department of Psychiatry, Shengjing Hospital of China Medical University, Shenyang, China. 3. Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, China. 4. The Third People's Hospital of Daqing, Daqing, China.
Abstract
BACKGROUND: The application of atypical antipsychotics (SGAs) for treatment of psychiatric and behavioral symptoms of dementia is controversial since their efficacy might be offset by their adverse events (AEs). OBJECTIVE: To assess the efficacy, safety, and tolerability of SGAs for treatment of psychological and behavioral symptoms of dementia. METHODS: Two researchers searched MEDLINE, PsychINFO, and the Cochrane Central Register of Controlled Trials independently for double-blind, placebo-controlled, randomized controlled trials (DB-PC-RCTs) as of June 2013, written in English. Efficacy was measured using the Brief Psychiatric Rating Scale (BPRS), Cohen-Mansfield Agitation Inventory (CMAI), Neuropsychiatric Inventory (NPI), Clinical Global Impression of Change (CGI-C), and (or) Clinical Global Impression of Severity (CGI-S). Safety and tolerability were measured by frequencies of drop-outs, AEs, and death. In total, 19 treatment comparisons drawn from 16 DB-PC-RCTs were included, and 3,343 patients randomized to the antipsychotic group and 1,707 to the placebo group were assessed. RESULTS: This meta-analysis demonstrated a significant efficacy of atypical antipsychotics on BPRS (MD = -1.58, 95% CI = -2.52 - -0.65), CMAI (-1.84, -3.01 - -0.61), NPI (-2.81, -4.35 - -1.28), CGI-C (-0.32, -0.44 - -0.20), and CGI-S (-0.19, -0.30 - -0.09), compared to placebo (p < 0.01 for all). Patients receiving atypical antipsychotics showed no difference in risk for discontinuation (p > 0.05), significantly higher risks (p < 0.05 for all) for somnolence (OR = 2.95), extrapyramidal symptoms (1.74), cerebrovascular AEs (2.50), urinary tract infection (1.35), edema (1.80), gait abnormality (3.35), and death (1.52), and a lower risk for agitation (OR = 0.80, p = 0.03). CONCLUSIONS: The higher risks for AEs and mortality may offset the efficacy of atypical antipsychotics for treatment of dementia. Efficacy, safety, and tolerability thus should be carefully considered against clinical need.
BACKGROUND: The application of atypical antipsychotics (SGAs) for treatment of psychiatric and behavioral symptoms of dementia is controversial since their efficacy might be offset by their adverse events (AEs). OBJECTIVE: To assess the efficacy, safety, and tolerability of SGAs for treatment of psychological and behavioral symptoms of dementia. METHODS: Two researchers searched MEDLINE, PsychINFO, and the Cochrane Central Register of Controlled Trials independently for double-blind, placebo-controlled, randomized controlled trials (DB-PC-RCTs) as of June 2013, written in English. Efficacy was measured using the Brief Psychiatric Rating Scale (BPRS), Cohen-Mansfield Agitation Inventory (CMAI), Neuropsychiatric Inventory (NPI), Clinical Global Impression of Change (CGI-C), and (or) Clinical Global Impression of Severity (CGI-S). Safety and tolerability were measured by frequencies of drop-outs, AEs, and death. In total, 19 treatment comparisons drawn from 16 DB-PC-RCTs were included, and 3,343 patients randomized to the antipsychotic group and 1,707 to the placebo group were assessed. RESULTS: This meta-analysis demonstrated a significant efficacy of atypical antipsychotics on BPRS (MD = -1.58, 95% CI = -2.52 - -0.65), CMAI (-1.84, -3.01 - -0.61), NPI (-2.81, -4.35 - -1.28), CGI-C (-0.32, -0.44 - -0.20), and CGI-S (-0.19, -0.30 - -0.09), compared to placebo (p < 0.01 for all). Patients receiving atypical antipsychotics showed no difference in risk for discontinuation (p > 0.05), significantly higher risks (p < 0.05 for all) for somnolence (OR = 2.95), extrapyramidal symptoms (1.74), cerebrovascular AEs (2.50), urinary tract infection (1.35), edema (1.80), gait abnormality (3.35), and death (1.52), and a lower risk for agitation (OR = 0.80, p = 0.03). CONCLUSIONS: The higher risks for AEs and mortality may offset the efficacy of atypical antipsychotics for treatment of dementia. Efficacy, safety, and tolerability thus should be carefully considered against clinical need.
Authors: Lise M Bjerre; Barbara Farrell; Matthew Hogel; Lyla Graham; Geneviève Lemay; Lisa McCarthy; Lalitha Raman-Wilms; Carlos Rojas-Fernandez; Samir Sinha; Wade Thompson; Vivian Welch; Andrew Wiens Journal: Can Fam Physician Date: 2018-01 Impact factor: 3.275
Authors: Lise M Bjerre; Barbara Farrell; Matthew Hogel; Lyla Graham; Geneviève Lemay; Lisa McCarthy; Lalitha Raman-Wilms; Carlos Rojas-Fernandez; Samir Sinha; Wade Thompson; Vivian Welch; Andrew Wiens Journal: Can Fam Physician Date: 2018-01 Impact factor: 3.275
Authors: Eleni Poptsi; Magda Tsolaki; Sverre Bergh; Bruno Mario Cesana; Alfonso Ciccone; Andrea Fabbo; Giovanni B Frisoni; Lutz Frölich; Sara Lavolpe; Anna Giulia Guazzarini; Jacques Hugon; Sara Fascendini; Carlo Alberto Defanti Journal: J Alzheimers Dis Date: 2021 Impact factor: 4.472