A comprehensive assessment of cholinesterase inhibitors for the treatment of Alzheimer's disease based on drug selection recommendations for Chinese medical institutions.

Abstract

Background: Cholinesterase inhibitors (ChEIs) are widely used to treat Alzheimer's disease (AD), yet the optimal choice remains unclear.

Research design and methods: This study aimed to comprehensively evaluate the overall clinical value of seven ChEI formulations to provide evidence‑based guidance for rational AD pharmacotherapy selection. We constructed an evaluation framework based on the Rapid Guide for Drug Evaluation and Selection in Chinese Medical Institutions (Second Edition), which combined mini‑health technology assessment with the System of Objectified Judgment Analysis (SOJA). Seven formulations were assessed across five weighted dimensions: pharmacological properties, efficacy, safety, economy, and other attributes. A systematic literature search was performed using PubMed, CNKI, Wanfang, and official regulatory databases.

Results: Within this assessment framework, donepezil tablets achieved the highest score (74.86), followed by rivastigmine patches (73.50) and rivastigmine capsules (72.28). These three formulations are recommended as priority options for inclusion in Chinese hospital formularies. The remaining four drugs may be prescribed according to individual patient conditions and available institutional resources.

Conclusions: This study provides evidence‑based guidance for clinical and institutional decision‑making in AD management and delivers a generalizable assessment framework adaptable to local real‑world data for healthcare institutions globally.