Efficacy of Pharmacological Interventions in Lewy Body Dementia: An Updated Systematic Review and Network Meta-Analysis
Aman Bhonsale1, Vinay Suresh2, Muneeb Ahmad Muneer3, Poorvikha S4, Malavika Rudrakumar5, Marium Khan6, Anmol Kaur7, Mohammad Hassan8, Sakshi sharma9, Apoorva Vedula10, Ishita Gupta11, Ishita Lanjewar12, Kshitij Sonawale13
1All India Institute of Medical Sciences, Nagpur, 2King George’s Medical University, 3Allama Iqbal Medical College, 4St John’s Medical College, 5St. John's medical college, 6Jinnah Sindh Medical University, 7Lady Hardinge Medical College and Associated Hospitals, 8Katihar Medical College, 9AIIMS nagpur, 10Osmania Medical College, 11Amrita Institute of Medical Sciences Kochi, 12Seth GSMC and KEM hospital, 13Seth GSMC and KEM Hospital
Objective:
To assess the efficacy of various pharmacological interventions for Lewy body dementia.
Background:
Lewy body dementia (LBD) causes progressive cognitive decline, muscle rigidity, tremors, and memory loss, severely impacting quality of life. This network meta-analysis (NMA) evaluates the efficacy of various pharmacological treatments for LBD, providing updated insights into optimal therapeutic approaches.
Design/Methods:
A systematic search of PubMed/MEDLINE, EMBASE, Scopus, Cochrane, and ClinicalTrials.gov was conducted to identify RCTs on LBD interventions up to June 2024. A Bayesian NMA evaluated drug effectiveness for LBD based on the Mini-Mental State Examination (MMSE) and the Neuropsychiatric Inventory (NPI). The analysis utilized the gemtc package in R, applying a random-effects model to account for heterogeneity and assessing convergence through trace plots and the Gelman-Rubin diagnostic, yielding posterior distributions for mean differences and 95% confidence intervals.
Results:
For the analysis of the primary outcomes, MMSE and NPI, 14 trials with a pooled population of 1,591 and 5 trials with a pooled population of 631 were included, respectively, resulting in 41 pairwise comparisons. Donepezil 5 mg showed a statistically significant mean difference (MD) of 2.2 (95% CI: 0.59 to 3.8), while Donepezil 10 mg had an MD of 1.8 (95% CI: 0.57 to 3.1), both with positive outcomes. In contrast, Exifone 600 mg had an MD of -6.4 (95% CI: -15 to 1.9). For NPI, Neflamapimod twice daily (BD) had an MD of -3.8 (95% CI: -12 to 4.5), which was not statistically significant. Bosutinib 100 mg showed higher incidences of serious adverse events (SAEs) and mortality, with odds ratios of 3.9 (95%: 1.3e-11 to 2.4e23) and 7.8e2 (95%: 2.8e-11 to 7.9e18), respectively.
Conclusions:
Donepezil 5 mg and 10 mg significantly improved MMSE scores in LBD patients. Neflamapimod (BD) showed non-significant improvement on the NPI scale, while Bosutinib 100 mg was linked to higher rates of SAEs and mortality.
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