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expert reaction to review paper looking at ibuprofen and Alzheimer’s disease

New research, published in the Journal of Alzheimer’s Disease, examines the association between daily ibuprofen use and potential prevention of Alzheimer’s disease.

 

Dr Carol Routledge, Director of Research at Alzheimer’s Research UK, said:

“Identifying the earliest signs of Alzheimer’s could enable future treatments to be given when they’ll be most effective but as yet, there is no simple test to identify those most at risk of the disease.  While a simple saliva test for Alzheimer’s sounds appealing, this is very early stage research that needs much more investigation before it could be considered clinically.

“While we know that targeting new treatments early is likely to bring the most benefits to people with dementia, this approach must be proven in well-designed clinical trials.  While this speculative review claims that ibuprofen could help prevent Alzheimer’s if given early, it does not contribute any new research evidence to assert this claim.

“Inflammation is an important area of Alzheimer’s research, but clinical trials into the potential benefits of anti-inflammatory drugs have yet to show conclusive benefits.  Any approach to test anti-inflammatory drugs like ibuprofen earlier in Alzheimer’s must be tested in carefully controlled clinical trials to establish safety and efficacy.  The long-term use of certain anti-inflammatories, like ibuprofen, can increase your risk of other health problems and there is currently insufficient evidence that they are effective or safe to use to prevent Alzheimer’s disease.”

 

Dr Doug Brown, Chief Policy and Research Officer, Alzheimer’s Society, said:

“With no way to slow down or cure dementia, finding a way to prevent the condition is one of the holy grails of dementia research.

“Population studies, which gather large amounts of information from medical records from thousands of people, have thrown up an idea that taking ibuprofen and other over-the-counter anti-inflammatories might be linked to a lower risk of dementia.  But results of clinical trials with these drugs have been disappointing so far.  The researchers’ suggestion in this paper that taking a daily anti-inflammatory drug as soon as a positive result for dementia risk is shown by a saliva test is premature, based on the evidence at the moment.

“Long-term use of anti-inflammatories runs an increased risk of stomach ulcers and intestinal bleeding, and can have harmful interactions with other medications like Warfarin.  We always recommend talking to your doctor before changing your medication.”

 

Prof Tara Spires-Jones, UK Dementia Research Institute Programme Lead and Deputy Director of the Centre for Discovery Brain Sciences, University of Edinburgh, said:

“This study does not report any new data on whether the use of anti-inflammatory drugs like ibuprofen can prevent Alzheimer’s disease.  Rather, it is a very preliminary description of a new test for levels of an Alzheimer’s related protein in saliva in around 50 people.  To determine whether this new test is a good predictor of people who will go on to develop Alzheimer’s disease will need much larger studies.

“The use of anti-inflammatory drugs like ibuprofen has been linked to reduced risk of developing Alzheimer’s disease in past studies of large populations.  However, these types of studies do not prove that anti-inflammatory drugs themselves actually decrease risk of disease, as other factors not related to the drugs could have the effect.  Scientists summarise this concept as ‘correlation does not imply causation’.  A good illustration of this is the fact that in children, shoe size correlates very strongly with reading ability.  However, it is not the size of the kids’ feet that causes their enhanced reading, rather the longer time they have spent learning to read, which coincidentally is also more time for their feet to grow.  Going back to anti-inflammatory drugs and dementia risk, it is still not clear whether this correlation with decreased dementia risk means the drugs cause the decreased risk.  Clinical trials using anti-inflammatory drugs in people who already have Alzheimer’s disease have failed, but it remains possible that using this type of drug many years before the disease starts could be preventative – but more work is needed to be sure.”

 

Prof John Hardy FMedSci, Professor of Neuroscience, UCL, said:

“This work from a pre-eminent Canadian group is of interest.  There is no doubt that inflammatory processes are part of the underlying biology of Alzheimer’s disease and this work does deserve serious consideration.  However, ibuprofen has been tried previously in a placebo controlled double blind trial and it failed.  We need to understand why it failed and whether the trial needs repeating.  It is certainly not ready for clinical use yet.  A saliva test for amyloid would be useful, but the utility of this requires replication by other groups before it would become accepted as clinically useful.”

 

* ‘Alzheimer’s disease can be spared by nonsteroidal anti-inflammatory drugs’ by Patrick L. McGeer et al. was published in the Journal of Alzheimer’s Disease on 13 March 2018. 

 

Declared interests

Prof John Hardy: “No conflicts.”

None others received.

 

 

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