Arthritis Drugs Flunk Alzheimer's Test
By Ed Edelson, HealthScoutNews Reporter
TUESDAY, June 3 (HealthScoutNews) -- Two well-known anti-inflammatory drugs used to treat arthritis have flunked a test to see whether they can stop the progression of Alzheimer's disease.
But the story of Alzheimer's and the drugs -- sold as Aleve and Vioxx -- isn't over yet, experts say.
The test by Georgetown University researchers was done partly because of laboratory evidence that inflammation plays a role in the damage of Alzheimer's disease and partly because epidemiological studies indicate that people who take these drugs appear to have a lower risk of developing the disease.
Nevertheless, the one-year study found the two drugs had no beneficial effect on people with mild to moderate disease, says a report in the June 4 issue of the Journal of the American Medical Association.
Both medications are nonsteroidal anti-inflammatory drugs (NSAIDs) with slightly different modes of action: Naproxen is a first-generation NSAID sold as Aleve and Naprosyn; rofecoxib is a newer drug, a Cox-2 inhibitor better known as Vioxx. Neither slowed progression of the disease, and both caused significant side effects, the study says.
Still, "because they did not work in this particular patient population does not say that they might not be useful in other populations," says Lenore J. Launer, chief of the neuroepidemiology section of the National Institute on Aging, who wrote an accompanying editorial.
The 351 patients in the study had well-established cases of Alzheimer's disease, classified as mild to moderate. Over the year, the continued decline in mental function, as measured by the standard Alzheimer Disease Assessment Scale Cognitive subscale, was about the same for those taking naproxen, rofecoxib or a placebo.
"The issue might be quite different in trying to slow progression at an earlier stage of the disease," Launer says. And it's possible NSAIDs might help prevent Alzheimer's. A trial looking at prevention in people at high risk because of a family history or other factors is ongoing, with results "three or four years away," Launer says.
"The result is a bit of a disappointment because everyone was hoping that NSAIDs would be effective in Alzheimer's patients," says Linda Van Eldick, a member of the Alzheimer's Association scientific advisory board. "But I don't think it's a kiss of death. We might find that the best use of NSAIDs is very early in the disorder or in primary prevention."
The idea is that "if inflammation reaches a certain point, these drugs may not be appropriate any more," Van Eldick says. "But it's not known when inflammation becomes so damaging that this type of drug is not effective."
There is even hope that NSAIDs can help some people in a more advanced stage of the condition, Launer adds. The patients in the trial were carefully chosen not to have cardiovascular conditions that would complicate the results, she says. Thus, NSAIDs might help Alzheimer's patients who do have cardiovascular problems.
It's also possible the risk factors for cardiovascular problems such as heart attack and stroke could increase the risk of Alzheimer's disease, Launer says.
"We know how to treat those risk factors such as high blood pressure and stroke quite well," she adds. "So if you take care of cardiovascular health, a side effect might be a reduction in Alzheimer's risk."
More information
To keep up with news on Alzheimer's disease, go to the Alzheimer's Association or the National Institute on Aging.
SOURCES: Lenore J. Launer, Ph.D, chief, neuroepidemiology branch, National Institute on Aging, Bethesda, Md.; Linda Van Eldick, Ph.D, professor, cell and molecular biology, Northwestern University School of Medicine, Chicago; June 4, 2003, Journal of the American Medical Association
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