KMCRIC

Efficacy and acceptability of anti-inflammatory eicosapentaenoic acid for cognitive function in Alzheimer's dementia: A network meta-analysis of randomized, placebo-controlled trials with omega-3 fatty acids and FDA-approved pharmacotherapy.

Tseng PT, Zeng BS, Suen MW, Wu YC, Correll CU, Zeng BY, Kuo JS, Chen YW, Chen TY, Tu YK, Lin PY, Carvalho AF, Stubbs B, Li DJ, Liang CS, Hsu CW, Sun CK, Cheng YS, Yeh PY, Wu MK, Shiue YL, Su KP.

Brain Behav Immun.

2023

111

352-64.

10.1016/j.bbi.2023.04.017.

37150266

http://www.ncbi.nlm.nih.gov/pubmed/37150266

Alzheimer Disease* / drug therapy
Anti-Inflammatory Agents / therapeutic use
Cognition
Eicosapentaenoic Acid / pharmacology
Eicosapentaenoic Acid / therapeutic use
Fatty Acids, Omega-3* / therapeutic use
Humans
Network Meta-Analysis
Randomized Controlled Trials as Topic

Alzheimer’s dementia; Cognition; Dementia; Network meta-analysis; Omega-3 fatty acid; Oxidation

알츠하이머 치매; 인지; 치매; 네트워크 메타분석; 오메가-3 지방산; 산화

KMCRIC 비평 보기 +

Alzheimer's dementia (AD) is a major contributor to global disability, and effective therapies to modify disease progression are currently lacking. The neuro-inflammatory theory is a potential etiology underlying this neurodegenerative disease. Previous randomized, controlled trials (RCTs) have provided inconclusive results regarding efficacy of omega-3 polyunsaturated fatty acids (PUFAs) regimens, which might provide anti-inflammatory benefits in the management of AD, in improving cognitive function among participants with AD. The objective of this frequentist-model based network meta-analysis (NMA) was to evaluate the potential advantages of omega-3 PUFAs and currently FDA-approved medications for AD on overall cognitive function in AD individuals. The primary outcomes were: (1) changes in cognitive function, and (2) acceptability, which refers to all-cause discontinuation. Additionally, secondary outcomes included quality of life, behavioral disturbances and safety/tolerability, which was assessed through the frequency of any reported adverse event. This NMA included 52 RCTs (6 with omega-3 PUFAs and 46 with FDA-approved medications) involving 21,111 participants. The results showed that long-term high-dose (1500-2000 mg/day) of eicosapentaenoic acid (EPA)-dominant omega-3 PUFAs augmented with anti-oxidants had the highest potential for cognitive improvement among all investigated treatments [standardized mean difference = 3.00, 95% confidence intervals (95 %CIs) = 1.84-4.16]. Compared to placebo, omega-3 PUFAs had similar acceptability [odds ratio (OR) = 0.46, 95 %CIs = 0.04 to 5.87] and safety profiles (OR = 1.24, 95 %CIs = 0.66 to 2.33)o. These findings support the potential neurotherapeutic effects of high dosage EPA-dominant omega-3 PUFAs for the amelioration of cognitive decline in patients with AD. Future large-scale, long-term RCTs should focus on different dosages of EPA-dominant omega-3 PUFAs regimens on improving cognitive dysfunction in patients with AD at different levels of inflammatory status and psychopathology.

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