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Evidence summaries

Galantamine for Alzheimer's Disease

With galantamine at doses of 16 mg/day or greater the decline of cognitive function is slightly lower compared to placebo, in people with mild to moderate Alzheimer's disease. Level of evidence: "A"

A treatment attempt with galantamine is recommended for slowing the cognitive decline in Alzheimer's disease as an alternative to other cholinesterase inhibitors.

The recommendation is strong because of possible positive effect on cognitive function. The cost of galantamine is low.

A Cochrane review [Abstract] 1 included 21 studies with a total of 10990 participants. The average age of the participants was 74 years, and 37% were male. Galantamine was most commonly given 8-12 mg twice daily, for total galantamine 16-24 mg/day.

  • Compared to placebo, galantamine improved: cognitive function, as assessed with the Alzheimer's Disease Assessment Scale - Cognitive Subscale (ADAS-cog, scale 1-70) (MD -2.86, 95% CI -3.29 to -2.43; 6 studies, n=3049, MCID = 2.6-4-point change); functional disability, as assessed with the Disability Assessment for Dementia (DAD, scale 0-100) scale (MD 2.12, 95% CI 0.75-3.49; 3 studies, n=1275); and behavioural function, as assessed with the Neuropsychiatric Inventory (NPI, scale 0-120) (MD -1.63, 95% CI -3.07 to -0.20; 2 studies, n=1043) at 6 months.
  • Galantamine improved global function at 6 months, as assessed with the Clinician's Interview-Based Impression of Change plus Caregiver Input (CIBIC-plus) (OR 1.58, 95% CI 1.36-1.84; 6 studies, n=3002).
  • Participants who received galantamine were more likely than placebo-treated participants to discontinue prematurely (22.7% versus 17.2%) (OR 1.41, 95% CI 1.19-1.68; 6 studies, n=3336), and experience nausea (20.9% versus 8.4%) (OR 2.89, 95% CI 2.40 to 3.49; 7 studies, n=3616) during the studies.
  • Galantamine reduced death rates at 6 months: 1.3% of participants in the galantamine groups had died compared to 2.3% in the placebo groups (OR 0.56, 95% CI 0.33-0.96; 6 studies, n=3493).

A systematic review [PubMed] 3 included 23 studies of which 4 assessed galantamine (n = 2265). Cognitive effects were significant at 24 weeks measured by the ADAS-cog using galantamine 24 mg/day (MD -3.03, 95% CI -3.66 to -2.41) and galantamine 32 mg/day (MD -3.2, 95% CI -3,28 to -3,12). No behavioral benefits were observed.

Clinical comments

Although the clinical benefits in the included studies were small, a treatment attempt is warranted due to the debilitating nature of the disease and its impact on the patient's quality of life.

Primary/Secondary Keywords