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Treatment efficacy and acceptability of pharmacotherapies for dementia with lewy bodies: a systematic review and network meta-analysis

Treatment efficacy and acceptability of pharmacotherapies for dementia with lewy bodies: a systematic review and network meta-analysis

Chu, Che-Sheng, Yang, Fu-Chi, Tseng, Ping-Tao, Stubbs, Brendon, Dag, Aarsland, Carvalho, Andre F., Thompson, Trevor ORCID: 0000-0001-9880-782X, Tu, Yu-Kang, Yeh, Ta-Chuan, Li, Dian-Jeng, Tsai, Chia-Kuang, Chen, Tien-Yu, Ikeda, Manabu, Liang, Chih-Sung and Su, Kuan-Pin (2021) Treatment efficacy and acceptability of pharmacotherapies for dementia with lewy bodies: a systematic review and network meta-analysis. Archives of Gerontology and Geriatrics, 96:104474. ISSN 0167-4943 (Print), 0167-4943 (Online) (doi:https://doi.org/10.1016/j.archger.2021.104474)

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Abstract

Introduction
We investigated the efficacy and acceptability of pharmacotherapy for dementia with Lewy bodies (DLB) while simultaneously considering the neuropsychiatric symptoms (NPS), cognitive function, motor symptoms, and acceptability.
Methods
Electronic databases were searched from inception through June 5, 2019, for randomized controlled trials (RCTs) and open-label trials (OLTs) in patients with DLB. We performed a pairwise conventional meta-analysis (PWMA) and network meta-analysis (NMA) within a frequentist framework. The main outcomes were mean change scores in NPS, general cognition, motor symptoms and acceptability. The effect sizes and odds ratios with 95% confidence intervals (CIs) were calculated. This study was registered with PROSPERO (CRD42018096996).
Results
In total, we included 29 studies (9 RCTs and 20 OLTs). In the NMA with 9 RCTs, both high- (mean difference [MD] 2.00, 95% CIs, 0.69 to 3.31) and low-dose (1.86, 0.58 to 3.15) donepezil were associated with a greater cognitive improvement than placebo. High-dose zonisamide was associated with greater motor symptom improvement ( -4.10, -7.03 to -1.17]). No medications reached statistical significance regarding improving neuropsychiatric symptoms or developing intolerable adverse effects as compared to placebo. In the second NMA, with 29 studies as an exploratory analysis, aripiprazole and yokukansan may be effective for neuropsychiatric symptoms, while levodopa may be associated with cognitive impairment.
Conclusions
We report the most comprehensive evidence for the selection of pharmacotherapy for treating different clusters of DLB-related symptoms. Due to the limited availability of RCTs on DLB, more well-conducted RCTs are needed for MMA to warrant clinical efficacy in the future.

Item Type: Article
Uncontrolled Keywords: Cognitive function; dementia with lewy bodies; lewy body disease; meta-analysis; neuropsychiatric symptoms
Subjects: R Medicine > R Medicine (General)
R Medicine > RS Pharmacy and materia medica
Faculty / School / Research Centre / Research Group: Faculty of Education, Health & Human Sciences
Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development
Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Chronic Illness and Ageing
Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM)
Related URLs:
Last Modified: 12 Oct 2021 09:36
Selected for GREAT 2016: None
Selected for GREAT 2017: None
Selected for GREAT 2018: None
Selected for GREAT 2019: None
Selected for REF2021: None
URI: http://gala.gre.ac.uk/id/eprint/33498

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