Abstract | BACKGROUND: OBJECTIVE: METHODS: We addressed the question through the development of a critically appraised topic. Participants included consultant and resident neurologists, clinical epidemiologists, a medical librarian, and behavioral neurology and movement disorder specialists. Participants began with a structured clinical question, devised search strategies, compiled the best evidence, performed a critical appraisal, summarized the evidence, provided commentary, and declared bottom-line conclusions. RESULTS: A randomized controlled trial (n = 541) showed that, compared with placebo, rivastigmine (mean, 8.6 mg/d) significantly improved scores on 2 coprimary cognitive outcome scales in PDD, including the Alzheimer disease Cooperative Study-Clinician's Global Impression of Change. When dichotomized to evaluate clinically significant benefit (moderate or marked improvement), this outcome was not significant (risk difference = 5.3%; 95% confidence interval (CI) = -1.6 to 12.1). The number needed to treat (NNT) to avoid clinically significant worsening of cognition was 10 (95% CI = 6-28). The NNT for the combined outcome of either achieving clinically significant benefit or avoiding significant worsening was 7. The numbers needed to harm for cholinergic side effects were 9 (95% CI = 5-24) for parkinsonian symptoms and 11 (95% CI = 6-32) for rivastigmine discontinuation due to any side effect. CONCLUSION:
Rivastigmine therapy for PDD is associated with significant tradeoffs in efficacy and adverse effects. Carefully monitored trials of rivastigmine may provide meaningful benefits for a minority of PDD patients.
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Authors | Amy C Almaraz, Erika D Driver-Dunckley, Bryan K Woodruff, Kay E Wellik, Richard J Caselli, Bart M Demaerschalk, Charles H Adler, John N Caviness, Dean M Wingerchuk |
Journal | The neurologist
(Neurologist)
Vol. 15
Issue 4
Pg. 234-7
(Jul 2009)
ISSN: 2331-2637 [Electronic] United States |
PMID | 19590387
(Publication Type: Case Reports, Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)
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Chemical References |
- Cholinesterase Inhibitors
- Phenylcarbamates
- Placebos
- Acetylcholine
- Rivastigmine
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Topics |
- Acetylcholine
(deficiency)
- Administration, Oral
- Aged
- Brain
(drug effects, metabolism, physiopathology)
- Cholinesterase Inhibitors
(administration & dosage, adverse effects)
- Cognition Disorders
(drug therapy, etiology, physiopathology)
- Disease Progression
- Humans
- Lewy Body Disease
(complications, psychology)
- Male
- Neuropsychological Tests
- Parkinson Disease
(complications, parasitology)
- Phenylcarbamates
(administration & dosage, adverse effects)
- Placebos
- Rivastigmine
- Treatment Outcome
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