Efficacy Of Cholinesterase Inhibitors In The Treatment Of Moderate To Severe Alzheimer’s Disease: A Systemic Review And Network META-analysis

Objective: Order to provide a direction for the using of drugs to improve cognitive function in patients with moderate to severe Alzheimer’s disease(AD),The Network Metaanalysis(NMA)was used to evaluate the efficacy of Choline esterase inhibitors(Ch EIs)on cognitive function in patients with moderate to severe AD.Methods: The literature published in PUBMED,Embase and Cochrane Library were searched before January 2023.The study included Randomized Controlled trials(RCTs)of AD patients with Mini-Mental State Examination(MMSE)score of 0 to 12.The changes of Severe Impairment Battery(SIB)score was as an evaluation index.A systematic review and network analysis of all included patients with moderate to severe AD was performed.Results: A total of 6 studies including 5 therapeutic drugs were included in this study,including 1844 patients with moderate to severe AD,the results of drug efficacy analysis showed that Donepezil 10 mg dose(MD = 6.3)= Donepezil 23 mg dose(MD = 6.3)>Donepezil 5 mg dose(MD = 5.4)> Galantamine 24 mg dose(MD = 5.2).Cumulative probability ranking showed that Donepezil 10 mg dose(0.699)> Donepezil 23 mg dose(0.674)> Donepezil 5 mg dose(0.559)> Galantamine 24 mg dose(0.535)> Placebo(0.032).Conclusion: Ch EIs can improve th e cognition of patients with moderate to severe AD.The dose of donepezil 10 mg is better than that of donepezil 23 mg,donepezil 5mg and galantamine 24 mg.