PLoS Medicine | www.plosmedicine.org 0457 The most recent systematic review of RCTs, by Hanna Kaduszkiewicz and colleagues, analyzed the scientiF c evidence for the clinical use of cholinesterase inhibitors in Alzheimer disease, together with the methodological quality of the trials . The authors concluded that the beneF ts are minimal, the methodological quality of the available trials is poor, and the scientiF c basis for recommendations of these drugs for Alzheimer disease is questionable . A similar conclusion was reported in the preliminary draft of recommendations on the use of cholinesterase inhibitors that is being developed by the United Kingdom’s National Institute for Health and Clinical Excellence (NICE), an independent organization responsible for providing national guidance on treating and preventing illness [12,13]. In its preliminary draft appraisal document, the organization stated “that the RCT evidence on outcomes of importance to patients and carers, such as quality of life and time to institutionalisation, was limited and largely inconclusive.” Moreover, the NICE committee reported that the quality of the reviewed trials was mixed, and that “the assessment group suspected selection bias, measurement bias and attrition bias.” The preliminary recommendations of the appraisal committee were that “donepezil, rivastigmine and galantamine are not recommended for use in the treatment of mild to moderate Alzheimer’s disease,” and that further research is required to identify subgroups of people for whom cholinesterase inhibitors may be effective. The committee recently updated its guidance, as shown in the
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