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Posted: March 11, 2008

Which Alzheimer's Drug Works Best? It's a Toss-up

The five drugs most commonly used to treat dementia in the United States all operate with roughly equal effects, indicating no one drug is better than another, according to new treatment guidelines issued to doctors.

A committee of the American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) issued the guidelines after reviewing studies describing the drugs’ effectiveness relating to cognition, global function, behavior and mood, and quality of life as determined by activities of daily living, among other indicators.

The result was a set of guidelines in which the physician committee urges the medical community to prescribe the approved dementia drugs based on an individual patient’s assessment, including a given patient’s ability to tolerate the drug, its adverse effects, ease of use and cost of the medication.

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At the same time, the committee urged that more clinical research be undertaken on an urgent basis to better understand the effectiveness of the various drugs it examined, indicating there could be differences in the medications that have not yet been clinically determined.

"More research is warranted, because the available evidence concerning these pharmaceuticals' effects on quality of life is mixed, and the clinical significance of many of the findings is questionable," Dr. Kenneth G. Schellhase, an AAFP representative on the committee, said in a prepared statement. "In addition, the duration of existing trials was usually less than one year, providing insufficient information to determine the optimal length of treatment, and few trials compare one drug directly with another."

The five drugs currently approved by the Food and Drug Administration to treat dementia, including Alzheimer’s, are donepezil (branded as Aricept), galantamine (Razadyne, Reminyl, Nivalin), rivastigmine (Exelon), tacrine hydrochloride (Cognex), and memantine (Namenda).

The guidelines are published in the journal Annals of Internal Medicine.

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