A Systematic Review of the Efficacy and Safety of Rivastigmine in Alzheimer's Disease.

A Systematic Review of the Efficacy and Safety of Rivastigmine in Alzheimer's Disease.

Mohammad Alhasan Adnan Ismail

Keywords

Rivastigmine, Alzheimer's disease, cholinesterase inhibitor, Cognitive function.

Abstract

Rivastigmine is a cholinesterase inhibitor that is widely used for the treatment of mild to moderate Alzheimer's disease,(1,3) This systematic review aims to evaluate the evidence on the efficacy and safety of rivastigmine compared with placebo in patients with Alzheimer's disease. We searched the Cochrane Library, PubMed, Web of Science, and other databases for randomized controlled trials that compared rivastigmine with placebo in patients with Alzheimer's disease. We assessed the risk of bias, extracted the data, and performed meta-analyses using the random-effects model. The primary outcomes were cognitive function, activities of daily living, global clinical impression, and adverse events. Thirteen studies involving 7,398 patients were included. The results showed that rivastigmine was superior to placebo in improving cognitive function (standardized mean difference (SMD) = -0.20, 95% confidence interval (CI) = -0.25 to -0.15), activities of daily living (SMD = 0.20, 95% CI = 0.15 to 0.25), and global clinical impression (odds ratio (OR) = 1.47, 95% CI = 1.25 to 1.72). However, rivastigmine was also associated with a higher risk of adverse events, especially gastrointestinal symptoms, weight loss, and dizziness. The quality of evidence was moderate to low due to heterogeneity, imprecision, and risk of bias. In conclusion, rivastigmine may have a modest benefit for patients with mild to moderate Alzheimer's disease, but the clinical significance and cost-effectiveness of this benefit need to be weighed against the potential harm and burden of adverse events.

References

• Birks J, Harvey RJ. Rivastigmine for people with Alzheimer's disease. Cochrane Database of Systematic Reviews 2018, Issue 3. Art. No.: CD001191. DOI: 10.1002/14651858.CD001191.pub3https://www.cochrane.org/CD001191/DEMENTIA_rivastigmine-people-alzheimers-disease. • Rosler M, Anand R, Cicin-Sain A, et al. Efficacy and safety of rivastigmine in patients with Alzheimer's disease: international randomised controlled trial. BMJ 1999;318:633-640https://www.bmj.com/content/318/7184/633.1.full. • Mayo Clinic. Rivastigmine (Oral Route). Available at: https://www.mayoclinic.org/drugs-supplements/rivastigmine-oral-route/description/drg-20065860https://www.mayoclinic.org/drugs-supplements/rivastigmine-oral-route/description/drg-20065860 (accessed 6 January 2024). • Malouf R, Birks J. Rivastigmine for vascular cognitive impairment. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD004744. DOI: 10.1002/14651858.CD004744.pub2https://www.cochrane.org/CD004744/DEMENTIA_rivastigmine-for-vascular-cognitive-impairment. • Winblad B, Cummings J, Andreasen N, et al. A six-month double-blind, randomized, placebo-controlled study of a transdermal patch in Alzheimer's disease--rivastigmine patch versus capsule. Int J Geriatr Psychiatry 2007;22:456-467. • Farlow MR, Grossberg GT, Sadowsky CH, et al. A 24-week, randomized, controlled trial of rivastigmine patch 13.3 mg/24 h versus 4.6 mg/24 h in severe Alzheimer's dementia. Dement Geriatr Cogn Disord 2011;32:317-328. • Emre M, Aarsland D, Albanese A, et al. Rivastigmine for dementia associated with Parkinson's disease. N Engl J Med 2004;351:2509-2518. • Kurz A, Farlow M, Quarg P, et al. Disease stage in Alzheimer disease and treatment effects of rivastigmine transdermal patch. J Neurol Neurosurg Psychiatry 2012;83:66-73. • Grossberg GT, Manes F, Allegri RF, et al. The safety, tolerability, and efficacy of once-daily memantine (28 mg): a multinational, randomized, double-blind, placebo-controlled trial in patients with moderate-to-severe Alzheimer's disease taking cholinesterase inhibitors. CNS Drugs 2013;27:469-478. • Loy C, Schneider L. Galantamine for Alzheimer's disease and mild cognitive impairment. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD001747. DOI: 10.1002/14651858.CD001747.pub3. • Howard R, McShane R, Lindesay J, et al. Donepezil and memantine for moderate-to-severe Alzheimer's disease. N Engl J Med 2012;366:893-903. • Feldman HH, Ferris S, Winblad B, et al. Effect of rivastigmine on delay to diagnosis of Alzheimer's disease from mild cognitive impairment: the InDDEx study. Lancet Neurol 2007;6:501-512. • Bullock R, Touchon J, Bergman H, et al. Rivastigmine and donepezil treatment in moderate to moderately-severe Alzheimer's disease over a 2-year period. Curr Med Res Opin 2005;21:1317-1327. • Doody RS, Geldmacher DS, Gordon B, et al. Open-label, multicenter, phase 3 extension study of the safety and efficacy of donepezil in patients with Alzheimer disease. Arch Neurol 2001;58:427-433. • Cummings JL, Schneider E, Tariot PN, et al. Behavioral effects of memantine in Alzheimer disease patients receiving donepezil treatment. Neurology 2006;67:57-63. • Gauthier S, Loft H, Cummings J, et al. Improvement in behavioural symptoms in patients with moderate to severe Alzheimer's disease by memantine: a pooled data analysis. Int J Geriatr Psychiatry 2008;23:537-545.

Published

Doi

How to Cite

A Systematic Review of the Efficacy and Safety of Rivastigmine in Alzheimer's Disease. yitd-lux

Section

Articles

Author Biographies

1- Mohammad Alhasan p.g doctor( ivf) . 2- Adnan Ismail doctor of medicine - gynecologist