Quetiapine not suitable for treating agitation in dementia
Quetiapine does not improve symptoms of agitation in patients with dementia, according to UK researchers. They also found that it increases cognitive decline among these patients and conclude that it should not be used to control symptoms.
The researchers randomised patients to either quetiapine (Seroquel, titrated
to 50mg twice daily), rivastigmine (Exelon, titrated to >=9mg daily)
or placebo and measured their degree of agitation and cognitive function
over 26 weeks.
In addition to showing no evidence that quetiapine and rivastigmine help
control agitation in patients in care facilities, the study revealed
that patients receiving quetiapine had significant decline in cognitive
function scores compared with placebo (P=0.01 at 26 weeks).
Patients in the rivastigmine group did not seem to show any significant
decline in cognitive
function.
“These results have clear implications for clinical practice,” say
the researchers. “Given current concerns about the risk
of stroke with risperidone and olanzapine [PJ, 13 March 2004, p307], further studies
are required to enable evidence-based pharmacological management of behavioural
disturbance in dementia.” They add that quetiapine should not be
used as an alternative to risperidone or olanzapine (published on BMJ
Online First).
AstraZeneca, manufacturers of Seroquel, said that the findings were inconsistent
with data from previous studies and that the maximum dose of quetiapine
used in the trial was too low. The company suggested that an effective
dose would be 200mg daily. |
The
Pharmaceutical Journal
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