Resumen del estudio
Cognitive dysfunction in people with systemic lupus erythematosus (SLE) — aka “lupus brain fog” — was significantly relieved with the Alzheimer’s dementia drug memantine in a small placebo-controlled trial.
Twelve weeks of memantine treatment led to a median improvement of 8 points on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), compared with a median 5-point increase with placebo in the 43-patient trial (P=0.032), according to Jillian Rhoads, PhD, of Vanderbilt University in Nashville, Tennessee, and colleagues.
Significantly more patients in the memantine arm gained at least 8 RBANS points — the standard threshold for clinically meaningful improvement — with treatment (12 vs 9 with placebo, P=0.047), the investigators reported in Annals of the Rheumatic Diseases.
Mecanismos subyacentes
Neuropsychiatric involvement is common in SLE, seen in up to 80% of cases, with memory and attention deficits. The exact mechanisms aren’t fully known, but SLE can disrupt the blood-brain barrier, allowing inflammatory elements to enter the central nervous system. In addition, autoantibodies may target structures in the brain, one of them being the N-methyl-D-aspartate (NMDA) receptor family.
Memantine is an NMDA receptor antagonist, binding the protein in such a way as to prevent its activation. It’s moderately effective in mild to moderate Alzheimer’s dementia, leading the researchers to hypothesize that it could help in NPSLE, via some combination of preventing autoantibody binding and reducing inflammation in the brain.
Resultados y limitaciones
Among the 43 who finished the trial, mean age was 43 and more than 90% were women. Interestingly, SLEDAI-2K scores declined quite a bit in the memantine arm, a median of 2.5 points by week 12 (IQR 0-10.0). Adverse effects weighed against memantine, as five patients in that group quit prematurely because of them, and not all were able to tolerate the maximum dose.
Limitations to the study included the small overall sample and the short duration.
Nota de descargo de responsabilidad
Los tratamientos y resultados discutidos en este artÃculo son solo informativos. Siempre consulte a un profesional de la salud antes de iniciar cualquier tratamiento o terapia.
Fuente: https://www.medpagetoday.com/rheumatology/lupus/122749
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