Memantine, Donepezil, or Combination Therapy—What is the best therapy for Alzheimer’s Disease? A Network Meta‐Analysis
Open accessAbstract
Introduction: Alzheimer's disease (AD) is a degenerative brain disease that progresses over time, heavily burdening patients, families, and aging societies worldwide. Memantine and donepezil are frequently used in its treatment, both as monotherapy and in combination. This multiple treatment comparison meta‐analysis assessed the efficacy of these regimens and placebo in the management of AD. Methods: We searched PubMed, Embase, the Cochrane Library, and Wanfang Med Online and China National Knowledge Infrastructure for English and Chinese publications from the first records to 17 April 2020. Two investigators scanned articles for placebo‐controlled trials of memantine and donepezil alone and in combination. We extracted data on the following outcomes: cognition, global assessment, daily activities, neuropsychiatric symptoms, adverse events, and the acceptability and cost of these treatment regimens. Results: Of 936 records screened, we included 54 trials in this analysis. The combination therapy was more effective in improving cognition (mean difference (MD)‐5.01, 95% credible interval (95% Crl) −10.73 to 0.86 in the Alzheimer's Disease Assessment Scale‐Cognitive Subscale; MD 9.61, 95% Crl 2.29 to 16.97 in the Severe Impairment Battery), global assessment (MD −2.88, 95% Crl −6.04 to 0.40), daily activities (MD 13.06, 95% Crl −34.04 to 58.92), and neuropsychiatric symptoms (MD −6.84, 95% Crl −10.62 to –2.82) compared with placebo. Memantine was more acceptable than placebo (MD 0.93, 95% Crl 0.69 to 1.22). Conclusions: Memantine plus donepezil showed superior outcomes for cognition, global assessment, daily activities, and neuropsychiatric symptoms, but lower acceptability than monotherapy and placebo. Combination therapy may be more cost‐effective, because memantine slows the progression of AD.
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Therapeutic Approach to Alzheimer’s Disease: Current Treatments and New Perspectives
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Combination Drug Therapy for the Management of Alzheimer’s Disease
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- Authors
- Guo, J., Wang, Z., Liu, R., Huang, Y., Zhang, N., & Zhang, R.
- Affiliations
- The Affiliated Yongchuan Hospital of Chongqing Medical University (CN)
- Corresponding author
- Wang, Zhenyu
- Venue
- Brain and Behavior
- Publisher
- Wiley
- Published
- 2020-09-10
- Volume
- 10
- Issue
- 11
- Pages
- e01831-e01831
- ISSN
- 2157-9032 (ISSN-L)
- 2162-3279
- PMC
- PMC7667299
- OpenAlex
- W3086164412
- Cited by
- 165
- References
- 10
- Citations by year
- 2026: 22 · 2025: 47 · 2024: 42 · 2023: 26 · 2022: 18 · 2021: 9 · 2020: 1
- FWCI
- 9.85
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Brain and Behavior (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Natural Science Foundation of China (81674066)
- Natural Science Foundation of Chongqing (cstc2017jcyjAX0397)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Pharmacology › Cholinesterase and Neurodegenerative Diseases
- Keywords
- Alzheimer's disease, memantine, donepezil, combination therapy, NMDA receptor antagonists, cholinesterase inhibitors, cognitive function, global assessment, activities of daily living, neuropsychiatric symptoms, treatment acceptability, cost-effectiveness, treatment efficacy
- MeSH terms
- Donepezil, Alzheimer Disease, China, Humans, Memantine
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