Abstract
Background: Initial observational studies and a systematic review published recently have suggested that non-steroidal anti-inflammatory drug (NSAID) use has the trend to be associated with reduced risk of Alzheimer's disease (AD), while results remain conflicting. Thus, we performed an updated meta-analysis to reevaluate the evidence on this association.Methods: Data sources from PUBMED, Embase and Cochrane Library from inception through April 2017 were searched by two independent reviewers. Eligible cohort studies were selected according to predefined keywords. We did a meta-analysis of available study data using a random-effects model to calculate overall relative risks (RRs) for associations between NSAID exposure and AD risk.Results: From 121 potentially relevant studies, 16 cohort studies including 236,022 participants, published between 1995 and 2016, were included in this systematic review. Meta-analysis demonstrated that current or former NSAID use was significantly associated with reduced risk of AD (RR, 0.81, 95% CI0.70 to 0.94) compared with those who did not use NSAIDs. This association existed in studies including all NSAID types, but not in aspirin (RR, 0.89, 95% CI 0.70 to 1.13), acetaminophen (RR, 0.87, 95% CI 0.40 to 1.91) or non-aspirin NSAID (RR, 0.84, 95% CI 0.58 to 1.23).Conclusions: Current evidence suggests that NSAID exposure might be significantly associated with reduced risk of AD. However, further large-scale prospective studies are needed to reevaluate this association, especially the associations in individual NSAID type.
Highlights
Non-steroidal anti-inflammatory drugs (NSAIDs), as one of the most widely prescribed medications, are mostly used for relief of pain or inflammatory conditions
Due to the conflicting results, we aimed to reevaluate the existing uncertainty regarding the effects of NSAID exposure on risk of Alzheimer disease (AD) by updating the systematic review and meta-analysis of cohort studies
Summarized data from the included 16 studies showed that for any NSAIDs without data separated for aspirin or acetaminophen, NSAID exposure was significantly associated with decreased risk of AD (RR 0.81, 95% CI, 0.70 to 0.94) with significant heterogeneity between studies (I2 = 75.6, P < 0.001) (Figure 2)
Summary
Non-steroidal anti-inflammatory drugs (NSAIDs), as one of the most widely prescribed medications, are mostly used for relief of pain or inflammatory conditions. Previous epidemiologic studies have indicated that NSAID use can offer a protective effect on the development of Alzheimer disease (AD) (Etminan et al, 2003; McGeer and McGeer, 2007; Vlad et al, 2008). Several epidemiologic studies showed that patients treated with NSAIDs had a decreased risk for developing AD (Breitner et al, 2009; Côté et al, 2012; Chang et al, 2016a,b) This evidence was only based on observational studies. Initial observational studies and a systematic review published recently have suggested that non-steroidal anti-inflammatory drug (NSAID) use has the trend to be associated with reduced risk of Alzheimer’s disease (AD), while results remain conflicting. We performed an updated meta-analysis to reevaluate the evidence on this association
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