000151663 001__ 151663 000151663 005__ 20250604100728.0 000151663 0247_ $$2doi$$a10.1001/jamanetworkopen.2020.6027 000151663 0247_ $$2altmetric$$aaltmetric:82963705 000151663 0247_ $$2pmid$$apmid:32463470 000151663 037__ $$aDZNE-2020-01242 000151663 082__ $$a610 000151663 1001_ $$aMaier, Franziska$$b0 000151663 245__ $$aBupropion for the Treatment of Apathy in Alzheimer Disease 000151663 260__ $$aChicago, Ill.$$bAmerican Medical Association$$c2020 000151663 3367_ $$2DRIVER$$aarticle 000151663 3367_ $$2DataCite$$aOutput Types/Journal article 000151663 3367_ $$0PUB:(DE-HGF)16$$2PUB:(DE-HGF)$$aJournal Article$$bjournal$$mjournal$$s1748960293_28492 000151663 3367_ $$2BibTeX$$aARTICLE 000151663 3367_ $$2ORCID$$aJOURNAL_ARTICLE 000151663 3367_ $$00$$2EndNote$$aJournal Article 000151663 520__ $$aImportance Apathy is a frequent neuropsychiatric symptom in dementia of Alzheimer type and negatively affects the disease course and patients’ and caregivers’ quality of life. Effective treatment options are needed.Objective To examine the efficacy and safety of the dopamine and noradrenaline reuptake inhibitor bupropion in the treatment of apathy in patients with dementia of Alzheimer type.Design, Setting, and Participants This 12-week, multicenter, double-blind, placebo-controlled, randomized clinical trial was conducted in a psychiatric and neurological outpatient setting between July 2010 and July 2014 in Germany. Patients with mild-to-moderate dementia of Alzheimer type and clinically relevant apathy were included. Patients with additional clinically relevant depressed mood were excluded. Data analyses were performed between August 2018 and August 2019.Interventions Patients received either bupropion or placebo (150 mg for 4 weeks plus 300 mg for 8 weeks). In case of intolerability of 300 mg, patients continued to receive 150 mg throughout the study.Main Outcomes and Measures Change on the Apathy Evaluation Scale–Clinician Version (AES-C) (score range, 18-72 points) between baseline and week 12 was the primary outcome parameter. Secondary outcome parameters included measures of neuropsychiatric symptoms, cognition, activities of daily living, and quality of life. Outcome measures were assessed at baseline and at 4, 8, and 12 weeks.Results A total of 108 patients (mean [SD] age, 74.8 [5.9] years; 67 men [62%]) were included in the intention-to-treat analysis, with 54 randomized to receive bupropion and 54 randomized to receive placebo. The baseline AES-C score was comparable between the bupropion group and the placebo group (mean [SD], 52.2 [8.7] vs 50.4 [8.2]). After controlling for the baseline AES-C score, site, and comedication with donepezil or galantamine, the mean change in the AES-C score between the bupropion and placebo groups was not statistically significant (mean change, 2.22; 95% CI, –0.47 to 4.91; P = .11). Results on secondary outcomes showed statistically significant differences between bupropion and placebo in terms of total neuropsychiatric symptoms (mean change, 5.52; 95% CI, 2.00 to 9.04; P = .003) and health-related quality of life (uncorrected for multiple comparisons; mean change, –1.66; 95% CI, –3.01 to –0.31; P = .02) with greater improvement in the placebo group. No statistically significant changes between groups were found for activities of daily living (mean change, –2.92; 95% CI, –5.89 to 0.06; P = .05) and cognition (mean change, –0.27; 95% CI, –3.26 to 2.73; P = .86). The numbers of adverse events (bupropion group, 39 patients [72.2%]; placebo group, 33 patients [61.1%]) and serious adverse events (bupropion group, 5 patients [9.3%]; placebo group, 2 patients [3.7%]) were comparable between groups.Conclusions and Relevance Although it is safe, bupropion was not superior to placebo for the treatment of apathy in patients with dementia of Alzheimer type in the absence of clinically relevant depressed mood.Trial Registration EU Clinical Trials Register Identifier: 2007-005352-17 000151663 536__ $$0G:(DE-HGF)POF3-344$$a344 - Clinical and Health Care Research (POF3-344)$$cPOF3-344$$fPOF III$$x0 000151663 588__ $$aDataset connected to CrossRef 000151663 7001_ $$0P:(DE-2719)2811324$$aSpottke, Annika$$b1$$udzne 000151663 7001_ $$aBach, Jan-Philipp$$b2 000151663 7001_ $$0P:(DE-HGF)0$$aBartels, Claudia$$b3 000151663 7001_ $$0P:(DE-2719)2811351$$aBürger, Katharina$$b4$$udzne 000151663 7001_ $$0P:(DE-HGF)0$$aDodel, Richard$$b5 000151663 7001_ $$aFellgiebel, Andreas$$b6 000151663 7001_ $$0P:(DE-2719)2811326$$aFliessbach, Klaus$$b7$$udzne 000151663 7001_ $$0P:(DE-HGF)0$$aFrölich, Lutz$$b8 000151663 7001_ $$aHausner, Lucrezia$$b9 000151663 7001_ $$aHellmich, Martin$$b10 000151663 7001_ $$aKlöppel, Stefan$$b11 000151663 7001_ $$aKlostermann, Arne$$b12 000151663 7001_ $$aKornhuber, Johannes$$b13 000151663 7001_ $$0P:(DE-2719)2000055$$aLaske, Christoph$$b14$$udzne 000151663 7001_ $$0P:(DE-2719)2811024$$aPeters, Oliver$$b15$$udzne 000151663 7001_ $$0P:(DE-2719)2811122$$aPriller, Josef$$b16$$udzne 000151663 7001_ $$aRichter-Schmidinger, Tanja$$b17 000151663 7001_ $$0P:(DE-HGF)0$$aSchneider, Anja$$b18 000151663 7001_ $$aShah-Hosseini, Kija$$b19 000151663 7001_ $$0P:(DE-2719)2000026$$aTeipel, Stefan$$b20$$udzne 000151663 7001_ $$avon Arnim, Christine A. 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