Long-term effects of galantamine on cognitive function in Alzheimer's disease: a large-scale international...

In Alzheimer's disease (AD), it is important to consider long-term effects, not only in patients receiving treatment, but also in subjects in whom therapy has been discontinued. The present analysis evaluates the long-term effects of galantamine on cognitive function in AD in terms of Mini-Mental State Examination (MMSE) scores for up to 7 years, using both clinical data and epidemiological modeling. Consideration is given not only to patients continuing to receive galantamine therapy, but also to those who stop this treatment. In a retrospective review of medical notes, re-contacted study investigators obtained data from 258 patients originally recruited into three previously described randomized clinical trials involving galantamine: two placebo-controlled trials in mild-to-moderate AD (of 3 and 6 months' duration, followed by open-label extensions) and the galantamine-treatment arm of a 12-month comparative study with donepezil in moderate AD. Information relating to disease progression was collated (up to five MMSE scores, separated by at least 3 months, for each patient). Changes in MMSE scores over time were evaluated using observed data. In the absence of long-term placebo, the rate of cognitive decline without treatment was projected using a previously described epidemiological model. A new, exploratory statistical model was also developed. Results showed that patients with mild-to-moderate AD who received long-term galantamine treatment exhibited attenuated decline in cognitive function, as assessed by MMSE, compared with decline predicted in the absence of treatment. Furthermore, patients who stopped treatment experienced subsequent cognitive decline at a rate similar to that predicted for untreated patients.