Functional outcomes of drug treatment in Alzheimer's disease - A systematic review and meta-analysis
Functional outcomes of drug treatment in Alzheimer's disease - A systematic review and meta-analysis
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DOI：
10.2165/00002512-200724020-00007
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发表时间：
2007-01-01
期刊：
影响因子：
2.8
通讯作者：
Kaufer, Daniel I.
中科院分区：
文献类型：
--
作者：
Hansen, Richard A.;Gartlehner, Gerald;Kaufer, Daniel I.
背景：患者功能是阿尔茨海默病的一个重要结果，但与治疗相关的患者功能改善很难量化，因为在其测量中使用了许多不同的量表。目的：系统地评估与患者功能相关的证据，作为阿尔茨海默病药物治疗的结果测量。数据通过搜索 MEDLINE (R)、EMBASE、Cochrane 图书馆和国际药物文摘 (International Pharmaceutical Abstracts) 获得，这些研究从 1980 年到 2005 年 12 月评估多奈哌齐、加兰他敏、卡巴拉汀和美金刚治疗阿尔茨海默病的功能结果。手动搜索参考列表，并邀请药品制造商提交档案。训练有素的评审员提取数据并使用预定义的标准评估试验的内部有效性（质量）。计算并定性和定量总结了各种功能结果量表的标准化效应大小（即科恩标准化平均差[d]）以及不良事件的汇总平均发生率和 95% CI。使用荟萃回归来探索潜在的异质性。结果：总体而言，纳入的研究中功能结果测量的标准化效应量较小（d = 0.1-0.4）。然而，效果大小始终有利于药物治疗而不是安慰剂。对于所有药物，短期（< 24 周；d = 0.25；95% CI 0.13, 0.37）和长期试验（
Background: Patient functioning is an important outcome in Alzheimer's disease, but treatment- related improvements in patient function are difficult to quantify because a number of different scales are used in its measurement.Objective: To evaluate systematically the evidence relating to patient functioning as an outcome measure in the drug treatment of Alzheimer's disease. Data were obtained by searching MEDLINE (R), EMBASE, The Cochrane Library and the International Pharmaceutical Abstracts from 1980 through to December 2005 for studies assessing functional outcomes with donepezil, galantamine, rivastigmine and memantine in Alzheimer's disease. Reference lists were searched manually and pharmaceutical manufacturers were invited to submit dossiers. Trained reviewers abstracted data and assessed the internal validity (quality) of trials using predefined criteria. Standardised effect sizes (i.e. Cohen's standardised mean difference [d]) for various functional outcome scales and pooled mean incidence and 95% CIs for adverse events were calculated and summarised qualitatively and quantitatively. Meta regression was used to explore potential heterogeneity.Results: Overall, the standardised effect size for functional outcome measures was small (d = 0.1-0.4) among included studies. However, effect sizes consistently favoured drug treatment over placebo. For all drugs, pooled standardised effect sizes were consistent in both short (< 24 weeks; d = 0.25; 95% CI 0.13, 0.37) and long trials (