Treatment Efficacy of Pharmacotherapies for Frontotemporal Dementia: A Network Meta-Analysis of Randomized Controlled Trials.

Humans Frontotemporal Dementia / drug therapy Network Meta-Analysis Piracetam Oxytocin Randomized Controlled Trials as Topic Treatment Outcome
Drug major neurocognitive disorder medication oxytocin systematic review

Journal

The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry
ISSN: 1545-7214
Titre abrégé: Am J Geriatr Psychiatry
Pays: England
ID NLM: 9309609

Informations de publication

Date de publication:
12 2023
Historique:
received: 29 04 2023
revised: 12 06 2023
accepted: 13 06 2023
medline: 10 11 2023
pubmed: 27 8 2023
entrez: 26 8 2023
Statut: ppublish

Résumé

The neuropsychiatric symptoms of frontotemporal dementia (FTD) have a profound negative impact on disease outcomes and care burden. Available pharmacotherapies might be supported by small-scale randomized controlled trials (RCTs); however, clinical recommendations might not be conclusive. We systematically searched several databases from inception to April 30, 2022, for RCTs of drug therapy in patients with FTD and neuropsychiatric symptoms (primary outcome). Secondary outcomes included changes in caregiver stress, daily interactive activities, cognitive function, and acceptability (adverse event or dropout rates). The network meta-analysis (NMA) procedure was performed under the frequency model, showing effect sizes as standardized mean differences (SMD) or odds ratios (OR) with 95% confidence intervals (95% CIs). Seven RCTs with 243 participants were included. Compared with placebo, high-dose oxytocin (72 international units) was associated with the greatest improvement in patients' neuropsychiatric symptoms (SMD = -1.17, 95% CIs = -2.25 to -0.08, z = -2.10, p = 0.035). Piracetam significantly worsened neuropsychiatric symptoms (SMD = 3.48, 95% CIs = 1.58 to 5.37, z = 3.60, p < 0.001) and caregiver stress (SMD = 2.40, 95% CIs = 0.80-4.01, z = 2.94, p = 0.003). Trazodone had significantly higher rates of adverse events (OR = 9.53, 95% CIs = 1.85-49.20, z = 2.69, p = 0.007). No pharmacological intervention significantly benefited cognitive function. This study provides the first NMA for clinical recommendation to support the use of high-dose oxytocin and caution regarding the use of piracetam for neuropsychiatric symptoms in patients with FTD.

Sections du résumé

BACKGROUND
The neuropsychiatric symptoms of frontotemporal dementia (FTD) have a profound negative impact on disease outcomes and care burden. Available pharmacotherapies might be supported by small-scale randomized controlled trials (RCTs); however, clinical recommendations might not be conclusive.
METHODS
We systematically searched several databases from inception to April 30, 2022, for RCTs of drug therapy in patients with FTD and neuropsychiatric symptoms (primary outcome). Secondary outcomes included changes in caregiver stress, daily interactive activities, cognitive function, and acceptability (adverse event or dropout rates). The network meta-analysis (NMA) procedure was performed under the frequency model, showing effect sizes as standardized mean differences (SMD) or odds ratios (OR) with 95% confidence intervals (95% CIs).
RESULTS
Seven RCTs with 243 participants were included. Compared with placebo, high-dose oxytocin (72 international units) was associated with the greatest improvement in patients' neuropsychiatric symptoms (SMD = -1.17, 95% CIs = -2.25 to -0.08, z = -2.10, p = 0.035). Piracetam significantly worsened neuropsychiatric symptoms (SMD = 3.48, 95% CIs = 1.58 to 5.37, z = 3.60, p < 0.001) and caregiver stress (SMD = 2.40, 95% CIs = 0.80-4.01, z = 2.94, p = 0.003). Trazodone had significantly higher rates of adverse events (OR = 9.53, 95% CIs = 1.85-49.20, z = 2.69, p = 0.007). No pharmacological intervention significantly benefited cognitive function.
CONCLUSIONS
This study provides the first NMA for clinical recommendation to support the use of high-dose oxytocin and caution regarding the use of piracetam for neuropsychiatric symptoms in patients with FTD.

Identifiants

DOI: 10.1016/j.jagp.2023.06.013 PMID: 37633762
pubmed: 37633762
pii: S1064-7481(23)00344-5
doi: 10.1016/j.jagp.2023.06.013
pii:
doi:

Substances chimiques

Piracetam ZH516LNZ10
Oxytocin 50-56-6

Types de publication

Systematic Review Meta-Analysis Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

1062-1073

Informations de copyright

Copyright © 2023 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Auteurs

Mao-Hsuan Huang (MH)

Department of psychiatry (M-HH), Yuanshan and Suao branches of Taipei Veterans General Hospital, Ilan, Taiwan; Division of Psychiatry (M-HH), Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.

Bing-Syuan Zeng (BS)

Institute of Biomedical Sciences (B-SZ, P-TT), National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Internal Medicine (B-SZ), E-Da Cancer Hospital, I-Shou University, Kaohsiung, Taiwan.

Ping-Tao Tseng (PT)

Institute of Biomedical Sciences (B-SZ, P-TT), National Sun Yat-sen University, Kaohsiung, Taiwan; Prospect Clinic for Otorhinolaryngology & Neurology (Y-WC, P-TT), Kaohsiung City, Taiwan; Department of Psychology (P-TT), Collage of Medical and Health Science, Asia University, Taichung, Taiwan; Institute of Precision Medicine (P-TT), National Sun Yat-sen University, Kaohsiung City, Taiwan.

Chih-Wei Hsu (CW)

Department of Psychiatry (C-WH), Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.

Yi-Cheng Wu (YC)

Department of Sports Medicine (Y-CW), Landseed International Hospital, Taoyuan, Taiwan.

Yu-Kang Tu (YK)

Institute of Epidemiology & Preventive Medicine (Y-KT), College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Dentistry (Y-KT), National Taiwan University Hospital, Taipei, Taiwan.

Brendon Stubbs (B)

Department of Psychological Medicine (BS), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Physiotherapy Department (BS), South London and Maudsley NHS Foundation Trust, London, UK; Positive Ageing Research Institute (PARI) (BS), Faculty of Health, Social Care Medicine and Education, Anglia Ruskin University, Chelmsford, UK.

Andre F Carvalho (AF)

Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre (AFC), School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia.

Chih-Sung Liang (CS)

Department of Psychiatry (C-SL), Beitou Branch, Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Sciences (C-SL), National Defense Medical Center, Taipei, Taiwan.

Tien-Yu Chen (TY)

Department of Psychiatry (T-YC), Tri-Service General Hospital; School of Medicine, National Defense Medical Center, Taipei, Taiwan; Institute of Brain Science (T-YC), National Yang Ming Chiao Tung University, Taipei 112, Taiwan.

Yen-Wen Chen (YW)

Prospect Clinic for Otorhinolaryngology & Neurology (Y-WC, P-TT), Kaohsiung City, Taiwan.

Kuan-Pin Su (KP)

Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab) (K-PS), China Medical University Hospital, Taichung, Taiwan; College of Medicine (K-PS), China Medical University, Taichung, Taiwan; An-Nan Hospital (K-PS), China Medical University, Tainan, Taiwan. Electronic address: cobol@cmu.edu.tw.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Treatment Efficacy of Pharmacotherapies for...
questionsmedicales.fr › Troubles mentaux › Troubles neurocognitifs › Démence › Dégénérescence lobaire frontotemporale › Démence frontotemporale › Treatment Efficacy of Pharmacotherapies for...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Méthodologie en recherche épidémiologique › Méta-analyse comme sujet › Méta-analyse en réseau › Treatment Efficacy of Pharmacotherapies for...
questionsmedicales.fr › Composés hétérocycliques › Composés hétéromonocycliques › Pyrrolidines › Pyrrolidones › Piracétam › Treatment Efficacy of Pharmacotherapies for...
questionsmedicales.fr › Acides aminés, peptides et protéines › Peptides › Hormones peptidiques › Hormones hypophysaires › Hormones post-hypophysaires › Ocytocine › Treatment Efficacy of Pharmacotherapies for...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études cliniques comme sujet › Essais cliniques comme sujet › Essais cliniques contrôlés comme sujet › Essais contrôlés randomisés comme sujet › Treatment Efficacy of Pharmacotherapies for...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Treatment Efficacy of Pharmacotherapies for...