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CONCLUSION: This study enhances the understanding of the relative benefits and risks associated with various VaD treatments, providing a valuable reference for clinical decision-making.
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Pharmacological treatments for vascular dementia: a systematic review and Bayesian network meta-analysis - PubMed

Pharmacological treatments for vascular dementia: a systematic review and Bayesian network meta-analysis

Chun Dang et al. Front Pharmacol. .

Abstract

Background: Vascular dementia (VaD) is one of the most prevalent, burdensome, and costly forms of dementia. Pharmacological treatment is often the first-line choice for clinicians; however, there is a paucity of comparative information regarding the multiple available drug options.

Methods and analysis: A systematic review and network meta-analysis were conducted on randomized trials involving adult patients with VaD, sourced from PubMed, the Cochrane Library, EMBASE, Web of Science, OPENGREY, ClinicalTrials.gov, Wanfang Data, and CNKI. The primary outcomes included changes in Mini-Mental State Examination (MMSE) scores, activities of daily living (ADL) scores, and the incidence of adverse reactions. Efficacy and safety of intervention strategies were comprehensively analyzed using forest plots, cumulative ranking probability curves (SUCRA), and funnel plots, all generated with R software.

Results: A total of 194 RCTs comparing 21 different anti-VaD drugs with placebos or no treatment were analysed. Regarding MMSE scores, the five most effective drugs were Butylphthalide, Huperzine A, Edaravone, Rivastigmine, and Memantine. For ADL scores, the top five drugs in efficacy were Huperzine A, Butylphthalide, Tianzhi granule, Nicergoline, and Idebenone. In terms of the incidence of adverse drug reactions, Co-dergocrine Mesylate, Tongxinluo capsule, Butylphthalide, Piracetam, and Oxiracetam demonstrated favourable safety profiles.

Conclusion: This study enhances the understanding of the relative benefits and risks associated with various VaD treatments, providing a valuable reference for clinical decision-making.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier registration number.

Keywords: Bayesian network meta-analysis; VAD; meta; treatment decision-making; vascular dementia.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1

PRISMA flow diagram.

FIGURE 2
FIGURE 2

Risk of bias summery for vascular dementia. (A) Risk of bias graph for vascular dementia; (B) Risk of bias summary for vascular dementia.

FIGURE 3
FIGURE 3

Conformance test for vascular dementia. Conformance test compares the posterior mean deviation of each data group between consistency and the ume m(b) Bias risk evaluation results displayed by including studies odel to judge the consistency among the included research.

FIGURE 4
FIGURE 4

Lever diagram for vascular dementia. The lever diagram shows the comparison between leverageik and Bayesian deviation residuals of all I tests and each of the K arms.

FIGURE 5
FIGURE 5

Funnel plots for systematic review and meta-analysis.

FIGURE 6
FIGURE 6

Network diagram of available comparisons. (A) MMSE scores; (B) ADL scores; (C) adverse effects rate.

FIGURE 7
FIGURE 7

Forest plots representing the efficacy and safety of patients with vascular dementia. (A) direct comparison for MMSE scores; (B) direct comparison for ADL scores; (C) direct comparison for adverse effects rate.

FIGURE 8
FIGURE 8

Ranking chart heat map. The heat map of each outcome index ranking table presented comparisons of the relative effects between any pair of interventions, including the OR and 95%CI of each outcome index in all intervention groups. (A) MMSE scores; (B) ADL scores; (C) adverse effects rate.

FIGURE 9
FIGURE 9

SSUCRA cumulative probability ranking curves and histogram. (A) histogram of MMSE scores; (B) SUCRA curve chart of MMSE scores; (C) histogram of ADL scores; (D) SUCRA curve chart of ADL scores; (E) histogram of adverse effects rate; (F) SUCRA curve chart of adverse effects rate.

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Publication types

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. National Natural Science Foundation of China (82001240), Natural Science Foundation of Heilongjiang Province (YQ2021H011), China Postdoctoral Science Foundation (2020M670925 and 2022T150172), and Postdoctoral Foundation of Heilongjiang Province (LBH‐Z19027 and LBH‐TZ2019).

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Pharmacological treatments for vascular dementia: a systematic review and Bayesian network meta-analysis – PubMed