Evidence map›Paper›PMID 28201726›Full record

SynthesisThe international journal of neuropsychopharmacology2017

Discontinuation, Efficacy, and Safety of Cholinesterase Inhibitors for Alzheimer's Disease: a Meta-Analysis and Meta-Regression of 43 Randomized Clinical Trials Enrolling 16 106 Patients.

Lídia Blanco-Silvente, Xavier Castells, Marc Saez, Maria Antònia Barceló, Josep Garre-Olmo, Joan Vilalta-Franch, Dolors Capellà

Open access · goldAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The international journal of neuropsychopharmacology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 64 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
64citing papers in PubMed, 6 pooled it
8.4field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

64 citing papers in PubMed, 6 syntheses or guidelines pooled it, 133 citations in OpenAlex.

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4 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 1 institution in 1 country.

Lídia Blanco-SilventeTransLab Research Group, and Department of Medical Sciences, University of Girona, Spain; Research Group on Statistics, Econometrics and Health, University of Girona, Spain; CIBER of Epidemiology and Public Health, Spain; Girona Biomedical Research Institute, Salt, Spain.
Xavier CastellsTransLab Research Group, and Department of Medical Sciences, University of Girona, Spain; Research Group on Statistics, Econometrics and Health, University of Girona, Spain; CIBER of Epidemiology and Public Health, Spain; Girona Biomedical Research Institute, Salt, Spain.
Marc SaezTransLab Research Group, and Department of Medical Sciences, University of Girona, Spain; Research Group on Statistics, Econometrics and Health, University of Girona, Spain; CIBER of Epidemiology and Public Health, Spain; Girona Biomedical Research Institute, Salt, Spain.
Maria Antònia BarcelóTransLab Research Group, and Department of Medical Sciences, University of Girona, Spain; Research Group on Statistics, Econometrics and Health, University of Girona, Spain; CIBER of Epidemiology and Public Health, Spain; Girona Biomedical Research Institute, Salt, Spain.
Josep Garre-OlmoTransLab Research Group, and Department of Medical Sciences, University of Girona, Spain; Research Group on Statistics, Econometrics and Health, University of Girona, Spain; CIBER of Epidemiology and Public Health, Spain; Girona Biomedical Research Institute, Salt, Spain.
Joan Vilalta-FranchTransLab Research Group, and Department of Medical Sciences, University of Girona, Spain; Research Group on Statistics, Econometrics and Health, University of Girona, Spain; CIBER of Epidemiology and Public Health, Spain; Girona Biomedical Research Institute, Salt, Spain.
Dolors CapellàTransLab Research Group, and Department of Medical Sciences, University of Girona, Spain; Research Group on Statistics, Econometrics and Health, University of Girona, Spain; CIBER of Epidemiology and Public Health, Spain; Girona Biomedical Research Institute, Salt, Spain.
Clínica Girona · ES

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: We investigated the effect of cholinesterase inhibitors on all-cause discontinuation, efficacy and safety, and the effects of study design-, intervention-, and patient-related covariates on the risk-benefit of cholinesterase inhibitors for Alzheimer's disease. Methods: A systematic review and meta-analysis of randomized placebo-controlled clinical trials comparing cholinesterase inhibitors and placebo was performed. The effect of covariates on study outcomes was analysed by means of meta-regression using a Bayesian framework. Results: Forty-three randomized placebo-controlled clinical trials involving 16106 patients were included. All-cause discontinuation was higher with cholinesterase inhibitors (OR = 1.66), as was discontinuation due to adverse events (OR=1.75). Cholinesterase inhibitors improved cognitive function (standardized mean difference = 0.38), global symptomatology (standardized mean difference=0.28) and functional capacity (standardized mean difference=0.16) but not neuropsychiatric symptoms. Rivastigmine was associated with a poorer outcome on all-cause discontinuation (Diff OR = 1.66) and donepezil with a higher efficacy on global change (Diff standardized mean difference = 0.41). The proportion of patients with serious adverse events decreased with age (Diff OR = -0.09). Mortality was lower with cholinesterase inhibitors than with placebo (OR = 0.65). Conclusion: While cholinesterase inhibitors show a poor risk-benefit relationship as indicated by mild symptom improvement and a higher than placebo all-cause discontinuation, a reduction of mortality was suggested. Intervention- and patient-related factors modify the effect of cholinesterase inhibitors in patients with Alzheimer's disease.

Indexed as

Randomized Controlled Trials as TopicTreatment OutcomeAlzheimer DiseaseCholinesterase InhibitorsDrug Administration ScheduleHumansOutcome Assessment, Health CareRegression AnalysisCholinesterase InhibitorsAlzheimer’s diseaseBayesian meta-analysischolinesterase inhibitordiscontinuationefficacy

Identifiers

PMID28201726
PMCPMC5492783
OpenAlexW2915651058

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.