1 / 9

Gauthier S., Loft H. and Cummings J.

Improvement in behavioural symptoms in patients with moderate to severe Alzheimer’s disease (AD) by memantine: a pooled data analysis. Gauthier S., Loft H. and Cummings J. International Journal of Geriatric Psychiatry 2008; 23: 537-45.

nile
Télécharger la présentation

Gauthier S., Loft H. and Cummings J.

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Improvement in behavioural symptoms in patients with moderate to severe Alzheimer’s disease (AD) by memantine: a pooled data analysis Gauthier S., Loft H. and Cummings J. International Journal of Geriatric Psychiatry 2008; 23: 537-45

  2. Behavioral Symptoms – a Distressing Aspect of AD • Behavioral symptoms • are common in moderate to severe AD • represent an aspect of disease burden that is physically, emotionally, and economically challenging • correlate with accelerated disease progression • There is a need for treatment options for patients with behavioral symptoms • Behavioral symptoms are a burdening and stressful factor for the family and caregiver Gauthier et al., Int J Geriar Psychiatry 2008

  3. Included Phase III Studies Phase III, double-blind, placebo-controlled, 6-month trials Study No. MMSE Inclusion Number of treated patients Range (Meana) Placebo Memantine MEM-MD-10 10 – 22 (17.3) 202 201 Peskind et al. 2006 LU-99679 11 – 23 (18.7) 152 318 Bakchine et al. 2007 MEM-MD-12 10 – 22 (16.9) 216 217 Porsteinsson et al. 2008 MRZ-9605 3 – 14 (7.9) 126 126 Reisberg et al. 2003 MEM-MD-01 5 – 14 (10.1) 172 178 Van Dyck et al. 2007 MEM-MD-02 5 – 14 (10.0) 201 202 Tariot et al. 2004 a all patients treated set Mecocci et al. XXX 2008

  4. Symptomatic Patients with MMSE < 20 at Baseline Pooled analysis of six studies (MMSE <20) Delusions Hallucinations Agitation/Agression Depression Anxiety Elation/Euphoria Apathy/Indifference Disinhibition Irritability/Lability Aberrant Motor Behavior Nighttime Behavior Appetite/Eating Change Memantine Placebo Proportion of patients (%) 40 10 20 30 50 60 0 Gauthier et al., Int J Geriar Psychiatry 2008

  5. Benefits of Memantine on Behavioral Symptoms FAS, OC analysis Mean change from baseline Pooled analysis of six studies (MMSE < 20) -1.5 -1.0 -0.5 0 0.5 1.0 1.5 2.0 2.5 p = 0.001 p = 0.035 Improvement p = 0.008 NPI score difference Memantine (20 mg/day) Placebo Decline 0 12 24/28 Endpoint (LOCF) Week Gauthier et al., Int J Geriar Psychiatry 2008

  6. Benefits of Memantine on Individual NPI Domains at Week 24/28 FAS, LOCF analysis Mean change from baseline Pooled analysis of six studies (MMSE < 20) p = 0.001 Delusions Hallucinations Agitation/Aggression Depression/Dysphoria Anxiety Elation/Euphoria Apathy/Indifference Disinhibition Irritability/Lability Aberrant Motor Behavior Nighttime Behavior Appetite/Eating Change p = 0.001 Memantine Placebo NPI domain score difference p = 0.005 0.6 0.4 0.2 0 -0.2 -0.4 Decline Improvement Gauthier et al., Int J Geriar Psychiatry 2008

  7. Improvement in Patients with Baseline Symptoms at Week 24/28 LOCF analysis Pooled analysis of six studies (MMSE <20) p = 0.045 Delusions Hallucinations Agitation/Aggression Depression/Dysphoria Anxiety Elation/Euphoria Apathy/Indifference Disinhibition Irritability/Lability Aberrant Motor Behavior Nighttime Behavior Appetite/Eating Change p = 0.028 Memantine Placebo Proportion of patients (%) p = 0.048 60 70 45 50 55 65 75 40 Gauthier et al., Int J Geriar Psychiatry 2008

  8. Percentage of Patients Remaining Asymptomatic at Week 24/28 LOCF analysis Pooled analysis of six studies (MMSE <20) Delusions Hallucinations Agitation/Aggression Depression/Dysphoria Anxiety Elation/Euphoria Apathy/Indifference Disinhibition Irritability/Lability Aberrant Motor Behavior Nighttime Behavior Appetite/Eating Change p = 0.002 Memantine Placebo Proportion of patients (%) p = 0.004 p = 0.050 95 75 80 85 90 100 70 Gauthier et al., Int J Geriar Psychiatry 2008

  9. Summary • Statistically significant benefit of memantine on behavioral symptoms (NPI total score) • Consistent effect on agitation/aggression  stated as the most problematic AD symptom • less emergence in patients asymptomatic at baseline • less worsening if present at onset of treatment • Anti-psychotic drugs are widely used off-label to treat behavioral symptoms in AD BUT • recent studies have shown no drug-placebo difference as well a substantial number of side effects compared to placebo (Schneider et al. 2006) • The FDA issued a Black Box warning against their use due associations with an increased mortality risk, cognitive decline, extrapyramidal symptoms, lowered blood pressure and sedation • The data support the efficacy of memantine in treating and preventing the emergence of behavioral symptoms Gauthier et al., Int J Geriar Psychiatry 2008

More Related