Abstract
Memantine (Axura®, Ebixa®, Namenda®) is an uncompetitive, moderate-affinity NMDA receptor antagonist that is indicated for the treatment of moderate to severe Alzheimer’s disease. In well designed trials in patients with moderate to severe Alzheimer’s disease, oral memantine monotherapy improved outcomes in the area of functional ability more than placebo in one trial, but in a second trial, treatment differences did not reach significance. Memantine has a distinct mode of action compared with that of acetylcholinesterase (AChE) inhibitors, and in a well designed study, combination therapy with memantine plus donepezil improved outcomes more than donepezil plus placebo in all four domains (function, cognition, behaviour and global change).
Memantine is generally well tolerated, with adverse events occurring with a similar incidence to that reported with placebo. In modelled cost-effectiveness analyses, memantine was dominant to no therapy in regard to cost per quality-adjusted life-year (QALY) gained, and the combination of memantine plus donepezil was dominant to donepezil therapy alone in regard to QALYs gained when treatment periods exceeded 1 year in patients with moderate to severe disease. Thus, in the management of patients with moderate to severe Alzheimer’s disease, memantine provides an effective treatment option. To date, clinical trial support is greater for memantine use in combination with an AChE inhibitor, while more data are needed to confirm its efficacy as monotherapy.
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Adapted and reproduced from CNS Drugs 2009; 23 (10): 881–97.[1] The full text article was reviewed by: D. Adamis, Research and Academic Institute of Athens, Athens, Greece; A. Atri, Department of Neurology and Massachusetts Alzheimer’s Disease Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA; S. Gauthier, McGill Center for Studies in Aging, Douglas Hospital, Verdun, Quebec, Canada; H. Kavirajan, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California, USA; M.C. Woodward, Aged and Residential Care Services, Heidelberg Repatriation Hospital, Heidelberg, Victoria, Australia. The manufacturer of the agent under review was offered an opportunity to comment on the original article during the peer review process; changes based on any comments received were made on the basis of scientific and editorial merit. The preparation of the original article and this spotlight was not supported by any external funding.
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McKeage, K. Spotlight on Memantine in Moderate to Severe Alzheimer’s Diseasey. Drugs Aging 27, 177–179 (2010). https://doi.org/10.2165/11204670-000000000-00000
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DOI: https://doi.org/10.2165/11204670-000000000-00000