No evidence of benefit of Ibuprofen for the treatment of Alzheimer's disease

There is increasing interest in non-steroidal antiinflammatory drugs (NSAIDs) for the treatment of Alzheimer's disease (AD). Extensive epidemiological surveys have suggested a lower prevalence of cognitive impairment in patients receiving long term treatment with NSAIDs. Animal and cell culture studies have produced evidence that inflammatory processes may be involved in the pathogenesis of AD. As a result, agents such as ibuprofen have been proposed for the treatment of people with AD. Although ibuprofen is better tolerated overall than some other NSAIDs, such as indomethacin, no randomized controlled trials investigating the efficacy of this drug for treatment of people with AD have been published. One such a trial is underway. The use of ibuprofen for the treatment of AD cannot at present be recommended.

Authors' conclusions: 

No evidence yet exists from randomized double-blind and placebo-controlled trials on whether ibuprofen is efficacious for patients diagnosed as having Alzheimer's disease. Ibuprofen, like other NSAIDs, has an identifiable and in some instances a significant side-effect profile which may include gastrointestinal bleeding. Therefore, it needs to be shown that the benefits of such a treatment outweighs the risk of side effects before ibuprofen can be recommended for people with Alzheimer's disease.

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Background: 

Non-steroidal antiinflammatory drugs such as ibuprofen may have a role in the treatment of conditions characterized by inflammatory processes. Ibuprofen may attenuate the effects of modulators of inflammation that have been implicated in the pathogenesis of Alzheimer's disease.

Objectives: 

To investigate the efficacy of ibuprofen treatment for people with Alzheimer's disease.

Search strategy: 

The trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 10 December 2002 using the (many) terms listed in the main text of the review. The CDCIG Register is updated regularly and contains records from all major health care databases and many ongoing trials databases.

In addition computerized databases and Internet sites pertaining to ibuprofen and Alzheimer's disease were systematically examined by two reviewers independently. Data on ongoing trials of ibuprofen for the treatment of people with AD were also sought.

Selection criteria: 

Eligibility for this review included all single or multi centre placebo-controlled randomized trials examining the efficacy of ibuprofen in the treatment of people diagnosed with Alzheimer's disease according to internationally accepted criteria. Inclusion and exclusion criteria were specified to ensure lack of bias in selection and methodological quality of selected trials.

Data collection and analysis: 

The aim was for the two reviewers NT and HF to collect data independently. The data selected would reflect cognitive, behavioural, physical and psychological domains of AD.

Main results: 

A systematic search of all available databases and other sources failed to identify any completed randomized, double-blind and placebo-controlled trials, assessing the efficacy of ibuprofen in AD eligible for inclusion in the review. One double-blind placebo-controlled trial investigating ibuprofen treatment for age-associated memory impairment has been identified, but is yet unfinished and no data are yet available. Other trials assessing the effect of ibuprofen on CSF beta amyloid in cognitively unimpaired individuals and the effect of other NSAIDs such as naproxen and rofecoxib for people with AD are currently underway.

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