AN INDIRECT TREATMENT COMPARISON OF UNAPPROVED TREATMENT OPTIONS OF ALZHEIMER’S DISEASE FOR RESEARCH PRIORITIZATION
Author(s)
Pandey R1, Jha D2, Pandey P1, Gupta P3, Shah V1
1SIRO Clinpharm Pvt Ltd, Maharashtra, India, 2Birla Institute of Technology, Ranchi, India, 3All India Institute of Medical Sciences, Patna, India
OBJECTIVES: There are several potential investigational therapies for Alzheimer’s disease with inconclusive evidence of efficacy. This network meta-analysis was conducted to compare these treatments indirectly and prioritize future research directions. METHODS: Indirect comparison of MMSE scores was conducted using STATA-13. The probability of each treatment for being most efficacious regimen was calculated using the difference against placebo, and counting the proportion of iterations of the Markov chain. RESULTS: A total of twenty-two studies were included. Overall 2,974 individuals were randomized to vitamins (cyanocobalamin, folic-acid, tocopherol), NSAIDs (indomethacin, piroxicam, ibuprofen, diclofenac+misoprostol), statins (atorvastatin, pravastatin, simvastatin), omega-3 fatty acids, sertraline, PBT2, xanthenes derivatives (denbufylline, propentofylline) or placebo. Results showed that simvastatin was the most efficacious regimen with a difference (95% prediction interval) of 0.91 (-3.26, 5.09) against denbufylline; 2.44 (-1.69, 6.57) against omega-3 fatty acid; 1.21 (-4.13, 6.55) against PBT2; 1.71 (-2.44, 5.86) against propentofylline; 0.58 (-3.82, 4.98) against atorvastatin; 2.76 (-1.27, 6.79) against cyanocobalamin; 3.48 (-1.31, 8.28) against diclofenac+misoprostol; 2.30 (-1.48, 6.08) against folic acid; 2.81 (-1.20, 6.82) against ibuprofen; 4.83 (-0.53, 10.20) against indomethacin; 2.21 (-0.98, 5.40) against placebo; 2.71 (-2.02, 7.44) against sertraline; and 2.61 (-0.89, 6.12) against tocopherol. The cumulative probabilities for being the best treatment were: simvastatin (39.4%), atorvastatin (23.0%), PBT2 (17.2%), denbufylline (12.9%), propentofylline (3.5%) sertraline (1.6%), other treatments (<1%). CONCLUSIONS: Of all the unapproved potential treatments of Alzheimer’s, statins and PBT2 showed a superior efficacy. Therefore, future further clinical investigations should consider statins and PBT2 as preferred candidates.
Conference/Value in Health Info
2017-05, ISPOR 2017, Boston, MA, USA
Value in Health, Vol. 20, No. 5 (May 2017)
Code
PRM8
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment
Disease
Neurological Disorders