回顾性研究发现治疗痴呆无特效药

hxq2007

Review finds no good drugs for dementia

By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) - There are no good drugs to treat dementia and doctors just need to try them in a hit-or-miss fashion to try to help patients, according to new guidelines released on Monday.

Experts who tried to set up treatment guidelines were disappointed to find no good options for patients with dementia, and no way to determine which drug might be best for certain cases.

\"There is no cure for dementia and many of the drugs ... are being prescribed without evidence,\" Dr. Amir Qaseem of the American College of Physicians, who led the study, said in a telephone interview.

\"The benefits of therapy may be very modest.\"

Qaseem and colleagues at the American Academy of Family Physicians reviewed the results of 96 different studies of five different drugs approved for treating dementia.

Four are in a class of drugs called cholinesterase inhibitors -- Pfizer and Eisai Co Inc's Aricept; galantamine, sold generically and under the brand names Razadyne, Reminyl and Nivalin; rivastigmine, sold by Novartis AG under the brand name Exelone; and tacrine, marketed to combat Alzheimer's disease under the brand name Cognex.

The fifth drug, memantine, is known as a neuropeptide -modifying agent and is sold by Forest Laboratories under the brand name Namenda.

The drugs can sometimes delay progression of the symptoms of dementia, which can take many different forms.

None works very well for people in general, although individual patients may see benefits, Qaseem said.

\"There is so much variation between individual patients,\" he said. And if doctors keep trying one drug after another, weeks and months can pass. In the end, he said, \"there might not be any effect at all.\"

Writing in the Annals of Internal Medicine, Qaseem and colleagues said they looked for evidence that the drugs helped cognition, global function, behavior, mood and quality of life.

Rather than trying to find the most effective drug, doctors should focus on tolerability, adverse effects, ease of use and cost, they recommended.

\"Doctors, patients and family care-givers desperately want information on how to treat this disease,\" Qaseem said.

\"It is disheartening to find out that all we have to work with is these five drugs, and the evidence on these is scant. Consider that in 50 years, one in 45 Americans will suffer from Alzheimer's disease. This is huge problem.\"

Drugs need to be tested head to head, the committee said, and combinations also should be tested.

\"More research is warranted because the available evidence concerning these pharmaceuticals' effects on quality of life is mixed and the clinical significance of many of the findings is questionable,\" said Dr. Kenneth Schellhase of the family physicians group.

The U.S. National Institutes of Health estimates that 2.4 million people have Alzheimer's disease and another 1 million have some other form of dementia in the United States, although advocacy groups put the figure at 5 million.

华盛顿（路透社）——根据周一发表的最新指南：治疗痴呆无特效药，医生们只能试着用偶然的方式来帮助患者。专家们尝试建立治疗痴呆方案，却很失望的发现治疗痴呆无特效药，也没有办法决定哪种药治疗痴呆效果最好。

主持这项研究的美国学院内科医师Dr. Amir Qaseem在电话采访中说：“痴呆尚无法治愈，许多处方药还没有证据证明是有效的。而且治疗的效果可能也很一般。”Qaseem和其在美国家庭医生学会的同事回顾了用5种不同的批准治疗痴呆的药来治疗96例研究结果。

其中四种是同一类药，叫胆碱酯酶抑制剂——辉瑞和Eisai公司的Aricept；加兰他敏是通用名，对应的品牌药是Razadyne、Reminyl和Nivalin；Novartis AG 销售的Exelone牌rivastigmine; Cognex牌的治疗阿尔茨海默病的tacrine。第五种药是一种神经肽——一种缓解剂，是Forest实验室开发的Namenda牌memantine。这些药物有时可通过不同的形式来延缓痴呆症状的进展。

Qaseem说：“尽管患者似乎是受益的，但实际上没有一种药是非常有效的。”他说：“不同患者间有变异。”如果医生试着一个接着一个的用药，那么就是在浪费时间。最后将不起一点作用。Qaseem和同事在内科学年鉴中写道他们在寻找关于药物有助于识别，恢复半球功能，行为，情感和生活质量的证据。他们建议，医生应把注意力集中在药物的耐受性，副作用，使用的便捷和价格上，而不是设法找到最有效的药物。

Qaseem说：“医生，患者和家庭护理员都非常想要关于如何治疗这种疾病的信息。”
“这五种药物的研究结果是非常令人沮丧的，其证据也是不充分的。在未来的50年里，每45个美国人中就有一个人要遭受阿尔茨海默疾病的困扰，这是一个严重的问题。”委员会说药品需要逐一验证，联合用药也需要经过验证。家庭医师Dr. Kenneth Schellhase说：“我们要保证更多的研究，因为现在关于这些药物对生活质量的影响是多方面的，许多结果的临床意义也是值得怀疑的。”

美国国立健康研究院估计在美国240万人患有阿尔茨海默病，另有100万人还有其他形式的痴呆，尽管一些倡导者要把这一数字放宽到500万人。
临床研究初步证实，鼻腔内低强度激光照射对痴呆有一定疗效