阿尔茨海默病和路易体痴呆治疗药物监测剂量优化:一项随机单盲临床试验

IF 2.8 Q2 NEUROSCIENCES
Journal of Alzheimer's disease reports Pub Date : 2024-11-24 eCollection Date: 2024-01-01 DOI:10.1177/25424823241289373
Michael Hén Forbord Fischer, Ivan Chrilles Zibrandtsen, Peter Johannsen, Volkert Siersma, Jan Borg Rasmussen, Jens Borggaard Larsen, Peter Høgh
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引用次数: 0

摘要

背景:先前的证据表明,多奈哌齐的血清浓度在临床人群中是不同的,高于标准的剂量可能对认知有额外的积极作用。治疗药物监测(TDM)是剂量优化(DO)的一种工具,根据先前的处方药物定量调整治疗。目的:探讨多奈哌齐或美金刚基于tdm的DO是否能改善常用这两种研究药物治疗的神经退行性疾病的临床结局和/或减少不良反应(ARs)的频率。方法:在某记忆门诊进行单盲1:1随机对照研究。新诊断为阿尔茨海默病痴呆(AD),路易体痴呆(DLB)或帕金森病痴呆(PDD)的符合条件的参与者计划用多奈哌齐或美金刚治疗。干预组接受基于TDM的DO治疗。对照组仅根据临床评估给予DO治疗。从基线到12个月,临床结果是迷你精神状态检查、阿登布鲁克认知检查、神经精神量表和痴呆残疾评估的变化。此外,还收集了ARs的发生率和严重程度以及血清浓度在治疗参考范围内的参与者比例的数据。结果:招募了132名参与者(125名AD, 7名DLB,无PDD),其中107人完成了研究(101名AD和6名DLB),对照组的人数少于计划。统计分析显示两组之间无论是临床结果还是ARs发生频率均无显著差异。结论:基于TDM的DO没有显著改善临床结果,也没有减少ARs的频率,尽管对结果有重要的注意事项。Clincialtrialsgov识别码:NCT04117178(首次发布于2019年10月7日)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Therapeutic drug monitoring for dose optimization in Alzheimer's disease and in dementia with Lewy bodies: A randomized single-blinded clinical trial.

Background: Previous evidence suggests serum concentrations of donepezil varies in clinical populations and that a dose higher than standard may have additional positive effect on cognition. Therapeutic drug monitoring (TDM) is a tool for dose optimization (DO) whereby treatment is adjusted based on previous quantification of the prescribed drug.

Objective: Investigate whether TDM-based DO of donepezil or memantine improves clinical outcomes and/or reduce the frequency of adverse reactions (ARs) in neurodegenerative conditions commonly treated with these two study drugs.

Methods: Single-blinded 1:1 randomized controlled study in an outpatient memory clinic. Eligible participants either newly diagnosed with Alzheimer's disease dementia (AD), dementia with Lewy bodies (DLB), or Parkinson's disease dementia (PDD) scheduled for treatment with donepezil or memantine. The intervention group received TDM based DO. The control group received DO solely based on clinical assessment. Clinical outcomes were change in Mini-Mental State Examination, Addenbrooke's Cognitive Examination, Neuropsychiatric Inventory, and Disability Assessment in Dementia from baseline to 12 months. Additionally, data on incidence and severity of ARs and proportion of participants with a serum concentration within the therapeutic reference range were collected.

Results: 132 participants recruited (125 AD, 7 DLB, none with PDD) of whom 107 completed the study (101 AD and 6 DLB), fewer in the control group than planned. Statistical analysis did not reveal significant differences between groups neither for clinical outcomes nor for frequency of ARs.

Conclusions: TDM based DO did not significantly improve clinical outcomes nor reduce the frequency of ARs albeit important caveats to the results apply.

Clincialtrialsgov identifier: NCT04117178 (first posted October 7, 2019).

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