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Evidence summaries

Aspirin, Steroidal and Non-Steroidal Anti-Inflammatory Drugs for the Treatment of Alzheimer's Disease

Aspirin, steroidal or non-steroidal anti-inflammatory drugs (both traditional NSAIDs and selective COX-2 inhibitors) appear not to be effective in Alzheimer's disease. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 14 studies with patients with Alzheimer's disease. MMSE ranged from 10-26; hence patients in these studies had mild to moderate disease. There were four interventions: aspirin (3 trials, n=352), steroids (one trials, n=138), traditional NSAIDs and selective cyclooxygenase-2 (COX-2) inhibitors (6 and 5 trials, respectively, n=1745). One study had two interventions including both a traditional NSAIDs and a selective COX-2 inhibitor. Most of the studies were carried on for one year, and only one study more than that. There was no significant improvement in cognitive decline for aspirin, steroid, traditional NSAIDs and selective COX-2 inhibitors. Compared to controls, patients receiving aspirin experienced more bleeding while patients receiving steroid experienced more hyperglycaemia, abnormal laboratory results and face edema. Patients receiving NSAIDs experienced nausea, vomiting, elevated creatinine, elevated LFT and hypertension. A trend towards higher death rates was observed among patients treated with NSAIDS compared with placebo and this was somewhat higher for selective COX-2 inhibitors than for traditional NSAIDs.

Comment: The quality of evidence is downgraded by study quality (aspirin studies were not double-blind RCTs, short follow-up time).

    References

    • Jaturapatporn D, Isaac MG, McCleery J et al. Aspirin, steroidal and non-steroidal anti-inflammatory drugs for the treatment of Alzheimer's disease. Cochrane Database Syst Rev 2012;2:CD006378. [PubMed]

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