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Review
. 2023 Jul 12;9(4):222-235.
eCollection 2023 Aug 31.

Safety and efficacy of intranasal insulin in patients with Alzheimer's disease: a systematic review and meta-analysis

Yosra Hussein AboEl-Azm  1 , Mohamed El-Samahy  1   2 , Nada Ibrahim Hendi  2   3 , Amina Arar  2   4 , Noha Samy Yasen  5 , Shrouk Ramadan  2   3 , Esraa M Zedan  2   6 , Nada Mostafa Al-Dardery  2   7 , Abdulrhman Khaity  2   8
Affiliations
Review

Safety and efficacy of intranasal insulin in patients with Alzheimer's disease: a systematic review and meta-analysis

Yosra Hussein AboEl-Azm et al. J Clin Transl Res. .

Abstract

Background and aim: We performed this meta-analysis to evaluate the safety and efficacy of intranasal insulin in Alzheimer's disease (AD) patients.

Methods: A literature search was conducted for PubMed, Scopus, and Web of Science from inception until August 2022. Documents were screened for qualified articles, and all concerned outcomes were pooled as risk ratios or mean difference (MD) in the meta-analysis models using Review Manager (RevMan version 5.4).

Results: Our results from 12 studies favored intranasal insulin over placebo in terms of Alzheimer Disease's Assessment Scale-cognitive subscale (ADAS-cog) 20 IU, (MD = -0.13, 95% CI [-0.22, -0.05], P = 0.003). The overall effect did not favor either of the two groups for ADAS-cog 40 IU, memory composite 20 IU and 40 IU, and adverse events (MD = -0.08, 95% CI [-0.16, 0.01], P = 0.08), (MD = 0.65, 95% CI [-0.08, 1.39], P = 0.08), (MD = 0.25, 95% CI [-0.09, 0.6], P = 0.15), and (MD = 1.28, 95% CI [0.75, 2.21], P = 0.36), respectively.

Conclusion: Ultimately, this meta-analysis showed that intranasal insulin in small doses (20 IU) significantly affects patients with AD. Further studies are recommended on reliable insulin delivery devices to increase insulin in the central nervous system.

Relevance for patients: Intranasal insulin has shown promising results in treating patients with AD. The lower doses (20 IU) can play a positive role in improving the disease. As research continues, it is likely that this treatment will become more widely accepted and utilized in clinical practice.

Keywords: Alzheimer’s disease; intranasal insulin; mild cognitive impairment.

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Conflict of interest statement

All authors have no conflicts of interest.

Figures

Figure 1
Figure 1. PRISMA flow diagram of studies’ screening and selection.
Figure 2
Figure 2. The risk of bias summary and risk of bias graph according to the Cochrane risk of bias assessment tool.
Figure 3
Figure 3. Forest plots of mean difference in (A) ADAS-cog 40 IU, (B) ADAS-cog 20 IU, (C) memory composite 40 IU, (D) memory composite 20 IU, (E) memory composite long-acting, and (F) DSRS 40 IU. Abbreviations: ADAS-cog: Alzheimer Disease’s Assessment Scale-cognitive subscale; DSRS: Dementia Severity Rating Scale.
Figure 4
Figure 4. Forest plots of mean difference in (A) DSRS 20 IU, (B) DSRS-LA, (C) ADCS-ADL 40 IU, (D) ADCS-ADL 20 IU, and (E) Clinical Dementia Rating-Sum of Boxes score. Abbreviations: DSRS: Dementia Severity Rating Scale; ADCS-ADL: Alzheimer’s disease Cooperative Study-activities of daily living.
Figure 5
Figure 5. Forest plots of mean difference in CSF Biomarkers of AD. Abbreviations: CSF: Cerebral Spinal Fluid; AD: Alzheimer’s disease.
Figure 6
Figure 6. Forest plots of risk ration in adverse events (Headache, Rhinitis/URI, and Fall). Abbreviations: URI: Upper respiratory infection.
See this image and copyright information in PMC

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