487 Rivastigmine has a small effect in Alzheimer’s disease

August 27, 2016

written by Brian R McAvoy

Clinical Question
How effective is rivastigmine for patients with Alzheimer’s disease (AD)?

Bottom Line
Rivastigmine (six to 12 mg daily orally or 9.5 mg daily transdermally) appeared to be beneficial for people with mild to moderate AD. Compared to placebo, better outcomes were observed for rate of decline of cognitive function and activities of daily living, although the effects were small and of uncertain clinical importance. There was also a benefit from rivastigmine on the outcome of clinician's global assessment. There were no differences between the rivastigmine group and placebo group in behavioural change or impact on carers. At these doses, the transdermal patch seemed to have fewer side effects than the capsules but had comparable efficacy. The trials lasted 12 to 52 weeks.

Caveat
The quality of evidence is only moderate for all of the outcomes reviewed because of a risk of bias due to participant dropout. All the studies with usable data were industry funded or sponsored. This review did not examine economic data. There were also concerns about the applicability of the evidence for the long-term treatment of AD, since data from double-blinded randomised controlled trials were only available for up to 12 months.

Context
AD is the commonest cause of dementia affecting older people. One of the therapeutic strategies aimed at ameliorating the clinical manifestations of AD is to enhance cholinergic neurotransmission in the brain through the use of cholinesterase inhibitors. These act by delaying the breakdown of acetylcholine released into synaptic clefts.

Cochrane Systematic Review
Birks JS and Grimley Evans J. Rivastigmine for Alzheimer’s disease. Cochrane Reviews, 2015, Issue 4. Art. No.: CD001191.DOI: 10.1002/14651858. CD001191.pub3. This review contains 13 studies involving 5,930 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.