Is there a future for donepezil therapy in the treatment of multiple sclerosis-related cognitive impairment?

Abstract

Evaluation of: Krupp LB, Christodoulou C, Melville P et al. Multicenter randomized clinical trial of donepezil for memory impairment in multiple sclerosis. Neurology 76(17), 1500–1507 (2011).

Cognitive impairment is a core feature of multiple sclerosis (MS), is detectable in up to 65% of patients and represents the most important predictor of the subject’s work and vocational status. The cognitive domains most frequently involved are attention, information processing speed, episodic memory and executive functions. To date, there is no approved drug or evidence-based strategy for the treatment of this disabling condition. Promising findings were provided in a monocentric randomized trial on donepezil – a reversible inhibitor of acetylcholinesterase – for the treatment of MS-related memory impairment. However, a larger multicentric trial failed to confirm any efficacy of donepezil on memory impairment in MS subjects. Possible implications of these findings are discussed in this article.

Keywords::

• acetylcholinesterase inhibitors
• cognitive impairment
• donepezil
• memory
• multiple sclerosis

Financial & competing interests disclosure

Emilio Portaccio serves on a scientific advisory board for Biogen-Idec and receives research support from Merck Serono, Biogen-Idec, Bayer Schering and Sanofi Aventis. Maria Pia Amato serves on scientific advisory boards for Biogen-Idec, Merck Serono, Bayer Schering and Sanofi Aventis and receives research support and honoraria for speaking from Biogen-Idec, Merck Serono, Bayer Schering and Sanofi Aventis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.