Aspirin, steroidal and non-steroidal anti-inflammatory drugs for the treatment of Alzheimer's disease

被引:222
作者
Jaturapatporn, Darin [1 ,2 ]
Isaac, Mokhtar Gad El Kareem Nasr [3 ]
McCleery, Jenny [4 ]
Tabet, Naji [5 ,6 ]
机构
[1] Mahidol Univ, Dept Family Med, Ramathibodi Hosp, Bangkok 10700, Thailand
[2] Univ Toronto, Baycrest Ctr Geriatr Care, Toronto, ON, Canada
[3] Sussex Partnership NHS Fdn Trust, Eastbourne, England
[4] Univ Oxford, Cochrane Dementia & Cognit Improvement Grp, Oxford, England
[5] Sussex Partnership NHS Fdn Trust, Inst Postgrad Med, Brighton & Sussex Med Sch, Brighton, E Sussex, England
[6] Sussex Partnership NHS Fdn Trust, Cognit Treatment & Res Unit, Brighton, E Sussex, England
来源
COCHRANE DATABASE OF SYSTEMATIC REVIEWS | 2012年 / 02期
关键词
MILD COGNITIVE IMPAIRMENT; PLACEBO-CONTROLLED-TRIAL; DOUBLE-BLIND; CLINICAL-TRIAL; RHEUMATOID-ARTHRITIS; ELDERLY-PATIENTS; PLASMA-CORTISOL; DHEA TREATMENT; OPEN-LABEL; DEMENTIA;
D O I
10.1002/14651858.CD006378.pub2
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Alzheimer's disease (AD) is the most common form of dementia. The incidence of AD rises exponentially with age and its prevalence will increase significantly worldwide in the next few decades. Inflammatory processes have been suspected in the pathogenesis of the disease. Objectives To review the efficacy and side effects of aspirin, steroidal and non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of AD, compared to placebo. Search methods We searched ALOIS: the Cochrane Dementia and Cognitive Improvement Group's Specialized Register on 12 April 2011 using the terms: aspirin OR "cyclooxygenase 2 inhibitor" OR aceclofenac OR acemetacin OR betamethasone OR celecoxib OR cortisone OR deflazacort OR dexamethasone OR dexibruprofen OR dexketoprofen OR diclofenac sodium OR diflunisal OR diflusinal OR etodolac OR etoricoxib OR fenbufen OR fenoprofen OR flurbiprofen OR hydrocortisone OR ibuprofen OR indometacin OR indomethacin OR ketoprofen OR lumiracoxib OR mefenamic OR meloxicam OR methylprednisolone OR nabumetone OR naproxen OR nimesulide OR "anti-inflammatory" OR prednisone OR piroxicam OR sulindac OR tenoxicam OR tiaprofenic acid OR triamcinolone OR NSAIDS OR NSAID. ALOIS contains records of clinical trials identified from monthly searches of a number of major healthcare databases (including MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS), numerous trial registries (including national, international and pharmacuetical registries) and grey literature sources. Selection criteria All randomised controlled trials assessing the efficacy of aspirin, steroidal and non-steroidal anti-inflammatory drugs in AD. Data collection and analysis One author assessed risk of bias of each study and extracted data. A second author verified data selection. Main results Our search identified 604 potentially relevant studies. Of these, 14 studies (15 interventions) were RCTs and met our inclusion criteria. The numbers of participants were 352, 138 and 1745 for aspirin, steroid and NSAIDs groups, respectively. One selected study comprised two separate interventions. Interventions assessed in these studies were grouped into four categories: aspirin (three interventions), steroids (one intervention), traditional NSAIDs (six interventions), and selective cyclooxygenase-2 (COX-2) inhibitors (five interventions). All studies were evaluated for internal validity using a risk of bias assessment tool. The risk of bias was low for five studies, high for seven studies, and unclear for two studies. 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 lab 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. Authors' conclusions Based on the studies carried out so far, the efficacy of aspirin, steroid and NSAIDs (traditional NSAIDs and COX-2 inhibitors) is not proven. Therefore, these drugs cannot be recommended for the treatment of AD.
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页数:115
相关论文
共 159 条
[1]   Aspirin in Alzheimer's disease (AD2000): a randomised open-label trial [J].
不详 .
LANCET NEUROLOGY, 2008, 7 (01) :41-49
[2]   Rofecoxib in patients with mild cognitive impairment: Further analyses of data from a randomized, double-blind, trial [J].
Aisen, Paul S. ;
Thal, Leon J. ;
Ferris, Steven H. ;
Assaid, Christopher ;
Nessly, Michael L. ;
Giuliani, Michael J. ;
Lines, Christopher R. ;
Norman, Barbara A. ;
Potter, William Z. .
CURRENT ALZHEIMER RESEARCH, 2008, 5 (01) :73-82
[3]   Glucocorticoids in Alzheimer's disease - The story so far [J].
Aisen, PS ;
Pasinetti, GM .
DRUGS & AGING, 1998, 12 (01) :1-6
[4]   Effects of rofecoxib or naproxen vs placebo on Alzheimer disease progression - A randomized controlled trial [J].
Aisen, PS ;
Schafer, KA ;
Grundman, M ;
Pfeiffer, E ;
Sano, M ;
Davis, KL ;
Farlow, MR ;
Jin, S ;
Thomas, RG ;
Thal, LJ .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2003, 289 (21) :2819-2826
[5]   A randomized controlled trial of prednisone in Alzheimer's disease [J].
Aisen, PS ;
Davis, KL ;
Berg, JD ;
Schafer, K ;
Campbell, K ;
Thomas, RG ;
Weiner, MF ;
Farlow, MR ;
Sano, M ;
Grundman, M ;
Thal, LJ .
NEUROLOGY, 2000, 54 (03) :588-593
[6]   Steroid-induced elevation of glucose in Alzheimer's disease: relationship to gender, apolipoprotein E genotype and cognition [J].
Aisen, PS ;
Berg, JD ;
Craft, S ;
Peskind, ER ;
Sano, M ;
Teri, L ;
Mulnard, RA ;
Thomas, RG ;
Thal, LJ .
PSYCHONEUROENDOCRINOLOGY, 2003, 28 (01) :113-120
[7]  
AISEN PS, 1994, AM J PSYCHIAT, V151, P1105
[8]   A pilot study of prednisone in Alzheimer's disease [J].
Aisen, PS ;
Marin, D ;
Altstiel, L ;
Goodwin, C ;
Baruch, B ;
Jacobson, R ;
Ryan, T ;
Davis, KL .
DEMENTIA, 1996, 7 (04) :201-206
[9]   Evaluation of selective COX-2 inhibitors for the treatment of Alzheimer's disease [J].
Aisen, PS .
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 2002, 23 (04) :S35-S40
[10]   Randomized pilot study of nimesulide treatment in Alzheimer's disease [J].
Aisen, PS ;
Schmeidler, J ;
Pasinetti, GM .
NEUROLOGY, 2002, 58 (07) :1050-1054