Fifteen trials were included in the review (6,114 randomised and 4,694 patients completing). Trial sample sizes ranged from 17 to 768 patients. Follow-up ranged from eight to 26 weeks. Trial quality was generally good: most trials scored 4 or 5 on the Jadad scale and none scored less than three. The reporting of harms data was limited and potentially biased.
Galantamine versus placebo (12 trials): Compared with placebo, galantamine was associated with a statistically significant greater cognition score (OR 2.14, 95% CI 1.85 to 2.48, I2=30%; nine trials), global assessment (OR 1.77, 95% CI 1.48 to 2.11, I2=17%; seven trials) and ADL (OR 1.40, 95% CI 1.22 to 1.61, I2=14%; six trials). Results for behaviour/mood were not significant (OR 1.13, 95% CI 0.87 to 1.47, I2=70%; five trials). Sensitivity analysis for behaviour/mood showed statistically significant results in favour of galantamine and statistical heterogeneity was reduced.
Galantamine versus other comparators (three trials): Evidence for galantamine versus donepezil (two trials) was equivocal. One trial of galantamine versus galantamine following washout after donepezil showed no difference in cognitive function.
Safety: The most commonly reported harms were nausea, diarrhoea and dizziness. Withdrawals due to harms ranged from 6% to 54% in the galantamine groups and zero to 17% in the placebo groups.