Comparative efficacy of lithium and aducanumab for cognitive decline in patients with mild cognitive impairment or Alzheimer's disease: A systematic review and network meta-analysis.
Aducanumab
Alzheimer’s disease
Cognitive decline
Cognitive function
Lithium
Mild cognitive impairment
Journal
Ageing research reviews
ISSN: 1872-9649
Titre abrégé: Ageing Res Rev
Pays: England
ID NLM: 101128963
Informations de publication
Date de publication:
11 2022
11 2022
Historique:
received:
09
07
2022
revised:
07
08
2022
accepted:
07
08
2022
pubmed:
13
8
2022
medline:
19
10
2022
entrez:
12
8
2022
Statut:
ppublish
Résumé
In 2021, the US Food and Drug Administration granted an accelerated approval to aducanumab for patients with mild cognitive impairment (MCI) and mild dementia caused by Alzheimer's disease (AD); however, the cost of aducanumab is high, at approximately $28,000 for one year per person. On the other hand, lithium is much cheaper at $40 a year, and has been reported to be effective for the cognitive decline observed in both patients with MCI and AD. In contrast to acetylcholinesterase inhibitors and N-methyl D-aspartate receptor antagonists, aducanumab and lithium may be disease-modifying drugs. Therefore, we focused on aducanumab and lithium and compared the effects of these drugs on the cognitive decline in MCI and AD patients using a network meta-analysis. PubMed, the Cochrane Library, CINHAL, and ClinicalTrials.gov were searched for randomized controlled trials testing lithium or aducanumab for the treatment of cognitive decline in patients with MCI or AD, up to January 31, 2022. A frequentist fixed-effect network meta-analysis was performed to estimate direct and indirect effects. The primary outcome was change scores in cognitive decline measured by Mini-Mental State Examination. This study has been registered with PROSPERO (number CRD42022304807). Network meta-analysis demonstrated that lithium was significantly more effective than aducanumab in the primary outcome. Although there were various limitations in this study, lithium may be a more cost-effective treatment than aducanumab for MCI and AD.
Sections du résumé
BACKGROUND
In 2021, the US Food and Drug Administration granted an accelerated approval to aducanumab for patients with mild cognitive impairment (MCI) and mild dementia caused by Alzheimer's disease (AD); however, the cost of aducanumab is high, at approximately $28,000 for one year per person. On the other hand, lithium is much cheaper at $40 a year, and has been reported to be effective for the cognitive decline observed in both patients with MCI and AD. In contrast to acetylcholinesterase inhibitors and N-methyl D-aspartate receptor antagonists, aducanumab and lithium may be disease-modifying drugs. Therefore, we focused on aducanumab and lithium and compared the effects of these drugs on the cognitive decline in MCI and AD patients using a network meta-analysis.
METHODS
PubMed, the Cochrane Library, CINHAL, and ClinicalTrials.gov were searched for randomized controlled trials testing lithium or aducanumab for the treatment of cognitive decline in patients with MCI or AD, up to January 31, 2022. A frequentist fixed-effect network meta-analysis was performed to estimate direct and indirect effects. The primary outcome was change scores in cognitive decline measured by Mini-Mental State Examination. This study has been registered with PROSPERO (number CRD42022304807).
RESULTS
Network meta-analysis demonstrated that lithium was significantly more effective than aducanumab in the primary outcome.
CONCLUSION
Although there were various limitations in this study, lithium may be a more cost-effective treatment than aducanumab for MCI and AD.
Identifiants
pubmed: 35961514
pii: S1568-1637(22)00151-9
doi: 10.1016/j.arr.2022.101709
pii:
doi:
Substances chimiques
Antibodies, Monoclonal, Humanized
0
Cholinesterase Inhibitors
0
aducanumab
105J35OE21
Lithium
9FN79X2M3F
Acetylcholinesterase
EC 3.1.1.7
Types de publication
Journal Article
Meta-Analysis
Review
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
101709Informations de copyright
Copyright © 2022 Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of interest Takeshi Inoue has received personal compensation from Mochida Pharmaceutical, Takeda Pharmaceutical, Eli Lilly, Janssen Pharmaceutical, MSD, Taisho Toyama Pharmaceutical, Yoshitomiyakuhin, and Daiichi Sankyo; grants from Shionogi, Astellas, Tsumura, and Eisai; and grants and personal compensation from Otsuka Pharmaceutical, Dainippon Sumitomo Pharma, Mitsubishi Tanabe Pharma, Kyowa Pharmaceutical Industry, Pfizer, Novartis Pharma, and Meiji Seika Pharma; and is a member of the advisory boards of Pfizer, Novartis Pharma, and Mitsubishi Tanabe Pharma. The other authors declare that they have no actual or potential conflicts of interest associated with this study.