Drugs for Alzheimer's disease

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7321.1127/a (Published 10 November 2001) Cite this as: BMJ 2001;323:1127

More effective agents are needed

  1. James Warner, senior lecturer in old age psychiatry,
  2. Rob Butler, consultant in old age psychiatry
  1. Faculty of Medicine, Imperial College of Science, Technology and Medicine, London W10 6DZ
  2. St Margaret's Hospital, Epping CM16 6TN
  3. Department of Geriatric Medicine, Royal Perth Hospital, Perth, WA 6000, Australia

    EDITOR—O'Brien and Ballard in their editorial outlined the approval by the National Institute for Clinical Excellence of cholinesterase inhibitors for the treatment of mild to moderate Alzheimer's disease.1 We believe, however, there are limitations in the evidence of the efficacy of cholinesterase inhibitors that should be considered.

    Pharmaceutical companies have sponsored most of the studies so far, which may lead to overestimation of the effect size.2 Many studies have been conducted in selected samples in secondary care, and the drugs may be less effective in the wider population. Most studies used “intention to treat” analyses (all randomised cases are included in the results, whether they completed the study or not) with “last observation carried forward” (including the last observation as the final result). Since people …

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