Groups Issue New Dementia Drug Guidelines

TUESDAY March 4, 2008 -- There's no proof that any one of the five drugs available in the United States to treat dementia is better than the others, says an American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) committee that just issued a new guideline on drug treatment of dementia.

The committee reviewed published studies for outcomes such as cognition, global function, behavior/mood, and quality of life/activities of daily living. But the committee said it found only limited high-quality scientific evidence about the effectiveness of the drugs and therefore developed the following cautious recommendations:

  • The decision to use approved drugs for dementia should be based on an individualized patient assessment.
  • The choice of drugs should be based on tolerability, adverse effect profile, ease of use, and cost.
  • There's an urgent need for more clinical research to improve knowledge about the clinical effectiveness of drugs treatment for dementia.

The committee recommended the following kinds of research:

  • Evaluate the effectiveness of drug therapy for dementia and assess whether treatments affect key outcomes, such as institutionalization.
  • Evaluate the appropriate duration of therapy.
  • Head-to-head testing of drugs.
  • Test drugs in combination therapy.

The guideline are published in the March 4 issue of the Annals of Internal Medicine.

Currently, there are five FDA-approved drugs for treatment of dementia. These include four acetylcholinesterase inhibitors -- donepezil (Aricept), galantamine (Razadyne, Reminyl, Nivalin), rivastigmine (Exelon), and tacrine -- and one neuropeptide-modifying agent -- memantine (Mamenda).

While these drugs may improve symptoms or slow disease progression, they don't cure dementia or repair brain damage.

"Doctors, patients and family caregivers desperately want information on how to treat this disease," Dr. Amir Qaseem, senior medical associate in the ACP's Clinical Programs and Quality of Care Department, said in a prepared statement. "It is disheartening to find that all we have to work with is these five drugs, and the evidence on these is scant. Consider that in 50 years, one in 45 Americans will suffer from Alzheimer's disease. This is a huge problem."

Most of existing studies of the five approved dementia drugs focused on statistical significance of changes, but clinically important improvement is what matters to patients, caregivers and doctors, the committee noted.

"More research is warranted, because the available evidence concerning these pharmaceuticals' effects on quality of life is mixed, and the clinical significance of many of the findings is questionable," Dr. Kenneth G. Schellhase, an AAFP representative on the committee, said in a prepared statement. "In addition, the duration of existing trials was usually less than one year, providing insufficient information to determine the optimal length of treatment, and few trials compare one drug directly with another."

More information

The Family Caregiver Alliance has more about dementia.

Posted: March 2008


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