Question:
In adults with Alzheimer’s dementia, how long are cholinesterase inhibitors effective?
Answer:
Evidence on the duration of effectiveness
of cholinesterase inhibitors was very limited. There was good
evidence, from two systematic reviews, that cholinesterase
inhibitors can provide short term (six months) benefits in patients
with mild to moderate Alzheimer's disease. Data from one randomised
controlled trial (RCT) and one an observational study, which used
follow-up data from participants in the galantamine arms of three
RCTs, suggest that continued galantamine treatment beyond 12 months
may be effective in slowing cognitive decline. However, it should
be noted that the RCT found no statistically significant
differences between the continued galantamine and discontinuation
groups in either the number of participants withdrawn from the
study due to a change in Assessment Scale Cognitive subscale
(ADAS-cog) score ≥4, or the mean global assessment with carer input
(CIBIC-plus) score. Further, no study included in this evidence
summary reported data showing any statistically significant
treatment effect for cholinesterase inhibitors (compared with
placebo) beyond six months. Further research is required to
establish the longer term effectiveness of cholinesterase
inhibitors in the management of patients with Alzheimer's
disease.