1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

Can NSAIDs Prevent Alzheimer Disease?

Neither celecoxib nor naproxen prevented AD or mild cognitive impairment.

Although inflammation plays a role in the pathogenesis of Alzheimer disease (AD), nonsteroidal anti-inflammatory drugs (NSAIDs) have not slowed the progression of early AD in several clinical trials (Journal Watch Feb 6 2004 and Journal Watch Jun 27 2003). But can NSAIDs prevent or delay the development of AD?

The ADAPT trial included people aged 70 or older who had no evidence of dementia or cognitive impairment, but had at least one first-degree relative with Alzheimer-like dementia. Participants were randomized to receive celecoxib (200 mg twice daily), naproxen (220 mg twice daily), or placebo. The trial was terminated in December 2004 when another study reported increased cardiovascular risk with celecoxib. At that point, 2528 people had been enrolled in ADAPT, and median follow-up was about 2 years (the original intent was 7 years of follow-up).

According to standardized cognitive testing and further evaluation of subjects with abnormal test results, neither celecoxib nor naproxen prevented AD or mild cognitive impairment. In fact, the annual risk for AD was higher in the celecoxib and naproxen groups (about 1%) than in the placebo group (about 0.5%), a difference that approached statistical significance.

Comment: In this halted study, neither celecoxib nor naproxen prevented Alzheimer disease, and there was a hint of harm. It remains possible that NSAIDs could prevent some cases of AD if started many years before disease onset, but a trial would have to be very large and protracted to address this possibility.

— Allan S. Brett, MD

Published in Journal Watch General Medicine May 29, 2007

Citation(s):

ADAPT Research Group. Naproxen and celecoxib do not prevent AD in early results from a randomized controlled trial. Neurology 2007 May 22; 68:1800-8.

• Original article (Subscription may be required)
• Medline abstract (Free)