胆碱酯酶抑制阿尔茨海默病:他克林试验的荟萃分析。痴呆症试验人员合作。
文章的细节
-
引用
复制到剪贴板 -
齐齐尔巴什N，怀特海德A，希金斯J，威尔科克G，施耐德L，法洛M
胆碱酯酶抑制阿尔茨海默病:他克林试验的荟萃分析。痴呆症试验人员合作。
《美国医学协会杂志》上。1998年11月25日;280(20):1777-82。
- PubMed ID
-
9842955 (PubMed视图］
- 摘要
-
目的:确定胆碱酯酶抑制与盐酸他克林对阿尔茨海默病症状在认知表现、临床整体印象、行为和功能自主方面的影响。数据来源:Cochrane痴呆组试验登记。研究选择:1996年1月1日前完成的无混淆、随机、双盲、安慰剂对照试验，给予他克林1天以上。数据提取:两名审稿人独立地选择了纳入的试验，并寻求个体患者数据。数据综合:数据分析来自12项试验，包括1984例阿尔茨海默病患者。12周时，通过简易精神状态检查(评分范围为0-30)测量，接受他克林治疗的患者的认知表现比接受安慰剂治疗的患者好0.62分(95%可信区间[CI]， 0.23-1.00;P = .002)。与类似未经治疗的患者相比，接受他克林治疗的患者在12周内的迷你精神状态检查(small mental State Examination)预计会恶化0.50 - 1.00分，而接受他克林治疗的患者的进展预计会在0.12分和0.38分之间改善。接受他克林治疗的患者与接受安慰剂治疗的患者相比，在临床整体变化印象量表(范围，1-7)上改善的优势比为1.58 (95% CI, 1.18-2.11;P = .002)。 The behavioral noncognitive subscale of the Alzheimer's Disease Assessment Scale (range, 0-50) showed a difference in favor of tacrine of 0.58 points (95% CI, 0.17-1.00; P= .006). Improvement on the Progressive Deterioration Scale, largely an index of functional activities, was not significant (0.75; 95% CI, -0.43 to 1.93; P=.21). Age, severity of dementia, and exposure to tacrine prior to randomization had no clear influence on the treatment effect. There was a nonsignificant trend toward increasing effect with increasing dose for cognitive function and the Clinical Global Impression of Change. For patients without prior exposure to tacrine, the odds of patients' withdrawing during the study while they were receiving tacrine compared with placebo was 3.63 (95% CI, 2.80- 4.71; P<.001). Eleven (95% CI, 7-31) patients would need to be treated to achieve any improvement on the Clinical Global Impression scale, and 42 (95% CI, 23-125) to achieve a moderate or marked improvement. One patient would be expected to withdraw for every 4 (95% CI, 3-5) patients treated. CONCLUSIONS: Cholinesterase inhibition with tacrine appears to reduce deterioration in cognitive performance during the first 3 months and increase the odds of global clinical improvement. Effects observed on measures of behavioral disturbance were of questionable clinical significance, and functional autonomy was not significantly affected. The clinical relevance of the benefits of cholinesterase inhibition remains controversial, and long-term trials with clinically relevant end points are required.
引用本文的药物库数据
- 药物