Concomitant use of cholinesterase inhibitors or memantine is associated with quicker cognitive decline in patients participating in Alzheimer clinical trials, according to a meta-analysis.
Patients with mild cognitive impairment due to Alzheimer disease (AD) in the observational Alzheimer Neuroimaging Initiative (ADNI) database who were receiving both cholinesterase inhibitors (ChEIs) and memantine had worse performance on various cognitive tests than those receiving only ChEIs.
It has been unclear whether such differences are also present in participants enrolling in clinical trials for AD, which typically allow participants to continue receiving stable doses of these medications.
Dr. Richard E. Kennedy of the University of Alabama at Birmingham and colleagues investigated whether concomitant use of ChEIs or memantine is associated with cognitive outcomes in AD clinical trials in a meta-analysis of 10 studies from the Alzheimer Disease Cooperative study and ADNI.
Among the 2,714 participants included in the analysis, 33.4% were receiving ChEIs, 5.3% were receiving memantine, 34.0% were receiving both and 27.3% were receiving neither. Patients receiving ChEIs or memantine were more likely to be in the placebo arm of trials.
Participants receiving ChEIs or memantine had lower (i.e., better) Alzheimer Disease Assessment Scale-cognitive (ADAS-cog) scores at baseline, but participants receiving both medications had more rapid cognitive decline over time than those not receiving these medications.