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随机试验中淀粉样蛋白水平降低并不能显著改善认知
作者:小柯机器人 发布时间:2021/2/28 18:41:34

美国加州大学旧金山分校M Maria Glymour团队分析了随机试验中淀粉样蛋白水平降低对认知改变的影响。2021年2月25日,《英国医学杂志》发表了该成果。

为了评估针对淀粉样蛋白药物的试验,以确定淀粉样蛋白水平的降低是否可能改善认知,研究组在ClinicalTrials.gov上检索了14项针对淀粉样蛋白机制、预防或治疗阿尔茨海默病药物的随机对照临床试验,进行辅助变量荟萃分析。纳入淀粉样蛋白靶向药物随机对照试验的成年人群,包括50岁及以上的成年人,诊断为轻度认知障碍或阿尔茨海默病,基线时淀粉样蛋白阳性。

分析包括一些试验,可获得通过淀粉样正电子发射断层扫描测量的大脑淀粉样蛋白水平的变化,以及每个随机组报告的至少一个认知测试分数的变化。

结果发现14个随机对照试验的汇总结果比任何单个试验的估计结果更精确。将淀粉样蛋白水平降低0.1个标准化摄取值比值单位的综合评估结果表明,最小精神状态检查得分改善0.03分。这项研究提供了一个网络应用程序,允许在新数据可用时重新估计结果,新证据是必需的,以实现支持降低淀粉样蛋白水平益处的综合评估。

从报告淀粉样蛋白水平降低和认知改变的现有试验中收集的证据表明,淀粉样蛋白降低策略并不能显著改善认知。

附:英文原文

Title: Effect of reductions in amyloid levels on cognitive change in randomized trials: instrumental variable meta-analysis

Author: Sarah F Ackley, Scott C Zimmerman, Willa D Brenowitz, Eric J Tchetgen Tchetgen, Audra L Gold, Jennifer J Manly, Elizabeth Rose Mayeda, Teresa J Filshtein, Melinda C Power, Fanny M Elahi, Adam M Brickman, M Maria Glymour

Issue&Volume: 2021/02/25

Abstract:

Objective To evaluate trials of drugs that target amyloid to determine whether reductions in amyloid levels are likely to improve cognition.

Design Instrumental variable meta-analysis.

Setting 14 randomized controlled trials of drugs for the prevention or treatment of Alzheimer’s disease that targeted an amyloid mechanism, identified from ClinicalTrials.gov.

Population Adults enrolled in randomized controlled trials of amyloid targeting drugs. Inclusion criteria for trials vary, but typically include adults aged 50 years or older with a diagnosis of mild cognitive impairment or Alzheimer’s disease, and amyloid positivity at baseline.

Main outcome measures Analyses included trials for which information could be obtained on both change in brain amyloid levels measured with amyloid positron emission tomography and change in at least one cognitive test score reported for each randomization arm.

Results Pooled results from the 14 randomized controlled trials were more precise than estimates from any single trial. The pooled estimate for the effect of reducing amyloid levels by 0.1 standardized uptake value ratio units was an improvement in the mini-mental state examination score of 0.03 (95% confidence interval 0.06 to 0.1) points. This study provides a web application that allows for the re-estimation of the results when new data become available and illustrates the magnitude of the new evidence that would be necessary to achieve a pooled estimate supporting the benefit of reducing amyloid levels.

Conclusions Pooled evidence from available trials reporting both reduction in amyloid levels and change in cognition suggests that amyloid reduction strategies do not substantially improve cognition.

DOI: 10.1136/bmj.n156

Source: https://www.bmj.com/content/372/bmj.n156

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj