Comparative efficacy and safety of antidepressant therapy for the agitation of dementia: A systematic review and network meta-analysis

Abstract

BackgroundDementia is a clinical syndrome commonly seen in the elderly individuals. With the prevalence of dementia, the incidence of neuropsychiatric symptoms in dementia patients is increasing annually. Agitation, as one of the neuropsychiatric symptoms, has a serious impact on the quality of life of patients with dementia. Several antidepressant drugs have been shown to be effective for treating agitated behavior symptoms in patients with dementia, but there are no direct comparisons among those drugs. Therefore, we carried out a network meta-analysis (NMA) to examine the efficacy and safety of those antidepressant drugs.MethodsWe searched eight databases (PubMed, Cochrane Library, Web of Science, Embase, Wanfang Database, China National Knowledge Infrastructure, VIP Database and China biomedical literature service) from their inception to 6 November 2022. Randomized controlled trials (RCTs) reporting the efficacy and safety of antidepressant drugs in treating agitated behavior symptoms in patients with dementia were included in our analysis. The quality assessment was carried out by two researchers individually and the analysis was based on the frequency method.ResultsTwelve articles with 1,146 participants were included in our analysis. Based on the outcome of the agitation score, treatment with citalopram (standardized mean difference, SMD = −0.44, 95% confidence interval, 95% CI = −0.72 to −0.16) showed significant benefits over the placebo group. Treatment with trazodone (odds ratio, OR = 4.58, 95% CI = 1.12–18.69) was associated with a higher risk of total adverse events compared with a placebo treatment.ConclusionAmong the antidepressant drugs included in this study, treatment with citalopram was probably the only optimal intervention, when considering the improvement from baseline to the end of the intervention, and there was not a statistically significant difference in safety when compared with a placebo treatment.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/#recordDetails, identifier: PROSPERO, CRD42022320932.

Effectiveness and tolerability of a novel blend of coq10, l-carnitine, zinc, lycopene, and astaxanthin in males with infertility: Findings from a UNESCO study

“…Moreover, various forms of carnitine, such as LC (L-carnitine), L-acetyl carnitine (LAC), or a combination of both (LAC and LC), have been shown to enhance sperm motility. Additionally, a recent network meta-analysis study found that zinc as an ~ 17 ~ antioxidant in supplementation improves sperm quality parameters in infertile men [23] .…”

Efficacy and safety of the innovative monoclonal antibodies in adults with generalized myasthenia gravis: a Bayesian network analysis

“…The global inconsistency by comparing the deviance information criterion (DIC) of the random-effect or fixed-effect model and the DIC less than 11 indicated better global consistency (29). Since all comparisons were monoclonal antibodies versus placebo or different drug dosages, and there was a lack of direct comparison of different monoclonal antibodies and no closed loops in the network plots, the node-splitting method examined the consistency was not performed (30). Besides, we performed heterogeneity analysis for each outcome in our NMA, and sensitivity analyses were further performed by excluding possible low evidence or possible high heterogeneity trials to evaluate the robustness of our findings.…”

Understanding neuropsychiatric symptoms in Alzheimer’s disease: challenges and advances in diagnosis and treatment

“…A systematic review published in March 2023 studied the efficacy of commonly used drugs to treat anxiety for anxiety in AD in randomized clinical trials against placebos. These studies showed that the efficacy using mirtazapine, sertraline, and trazodone did not result in a statistically significant difference when compared to the placebo (SMD = −0.08; 0.31; and 0.03, respectively) ( Chen et al, 2023 ). However, 5-HT anti-depressants such as Citalopram showed an efficacy of 94.8% (SMD = −0.44, 95% CI = −0.72 to −0.16) when compared to placebo and other anti-depressant drugs ( Albert et al, 2012 ).…”