Anti-inflammatory drugs ineffective for prevention of Alzheimerās disease
Study sheds light on longstanding debate
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Researchers have known for decades that inflammation accompanies Alzheimerās disease (AD) brain lesions. Several early studies suggested that āsuper-aspirinsā or Nonsteroidal anti-inflammatory drugs (NSAID) could help avoid the disease. However, after clinical trials showed that NSAIDs donāt help patients who already have AD symptoms, doctors wondered whether these drugs could still be helpful to people who were at risk of developing the disease, but werenāt yet showing symptoms.
To test this hypothesis, researchers at ±«ÓćÖ±²„ās Faculty of Medicine developed a new approach to AD prevention trials, and used it to test whether the common NSAID naproxen could indeed stop the disease in its tracks, before people developed AD symptoms. Sadly, the results were not encouraging, according to research published in the April 5, 2019, online issue of Ā®, the medical journal of the American Academy of Neurology.
āTo give the NSAID story one more chance to end well, we enrolled trial participants at the earliest stages of disease development, before they exhibited cognitive impairment,ā explains Dr. John Breitner, Professor of Psychiatry at ±«ÓćÖ±²„ and the studyās senior author. āThe resulting trial, known as INTREPAD, examined the effects of naproxen in people who had a strong family history of AD but āsqueaky-cleanā memory and other cognitive abilities.ā
Developing a new method to assess effectiveness
Many researchers have noted the special challenge of measuring disease development at a time when they could not rely on symptoms to assess effects of a treatment. To deal with this challenge the ±«ÓćÖ±²„ team collaborated in developing a new Alzheimer Progression Score (APS) that was shown elsewhere to predict the onset of clinical disease over the coming decade or more. The APS measures the early development of disease by combining many little changes into a composite score.
Applying the APS to a trial sample of 200 people (100 assigned to naproxen and 100 to placebo), the INTREPAD results showed real changes over the two-year trial period. However, there was no evidence that the APS change was reduced in those taking naproxen. āThe usual side effects were there,ā notes Pierre- FranƧois Meyer, a PhD candidate in Dr. Breitnerās lab and the studyās first author, ābut there was not the slightest suggestion of any benefit.ā
āWe think this is the end of the road for the use of NSAIDs for treatment or prevention of Alzheimerās disease, and it suggests a need for caution about using other anti-inflammatory drugs for this purpose,ā adds Dr. Breitner, who is Founding Director of the Centre for Studies on Prevention of Alzheimerās Disease at the Research Centre of the Douglas Mental Health University Institute. āThe world desperately needs a way to prevent this horrible disease,ā he says, āand many other avenues are being investigated.ā In this process, researchers argue ever more strongly for the importance of publishing negative or ānullā trial results like this one.
āINTREPAD: A randomized trial of naproxen to slow progress of presymptomatic Alzheimer disease,ā by Pierre-FranƧois Meyer, John Breitner, et al, was published online in the journal ±·±š³Ü°ł“Ē±ō“Ē²µ²āĀ® on April 5, 2019 doi:10.1212/WNL.0000000000007232
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Contact:
Jason Clement
Communications Officer,
Faculty of Medicine,
±«ÓćÖ±²„
514-398-5909
Jason.clement [at] mcgill.ca