Nonsteroidal Anti-Inflammatory Drugs and the Risk of Parkinson Disease

Abstract

Background: Several lines of evidence suggest a role of inflammatory processes in Parkinson disease, although it is still unclear whether inflammation is a cause or rather a consequence of neurodegeneration. Methods: In a prospective population-based cohort study among 6,512 participants aged ≧55 years, with repeated in-person examination, we evaluated the association between cumulative use of nonsteroidal anti-inflammatory drugs (NSAIDs) and the risk of Parkinson disease. Complete information on filled prescriptions was available from automated pharmacy records. Data were analyzed by means of Cox proportional hazards regression analysis, adjusted for age, sex, smoking habits and coffee consumption. Results: After an average 9.4 years of follow-up, 88 new cases of Parkinson disease were detected. No association was found between use of NSAIDs and the risk of Parkinson disease (adjusted hazard ratio for any NSAID use, 1.50; 95% confidence interval, 0.95–2.37). Conclusion: Our findings do not support the hypothesis that NSAIDs might decrease the risk of Parkinson disease.

Neuroinflammation in the pathophysiology of Parkinson’s disease and therapeutic evidence of anti-inflammatory drugs

“…Therefore, no indication of protection from ASA or other NSAIDs was recognized through this study. Bornebroek and colleagues 40 obtained similar results. They did a prospective population-based cohort study among 6,512 participants of 55 years old or older, and found no association between the use of NSAIDs and risk of developing PD.…”

Epidemiology and etiology of Parkinson’s disease: a review of the evidence

“…A meta-analysis of results from all three cohorts gave a RR estimate of 0.74 (95% CI 0.58-0.93) for ever versus never use of non-aspirin NSAID [558]. In contrast, the Rotterdam prospective study reported no association between NSAIDs and PD [559].…”

Can anti-inflammatory agents protect against Parkinson‘s disease?

“…Another study conducted by the same group in the American Cancer Society cohort, however, suggested protection only for daily users of one specific NSAID, ibuprofen, and not aspirin [18]. A much smaller Dutch cohort found no association or a small risk increase among ever users of NSAIDs, but only six PD cases reported use of these medications for more than 1 year [26].…”

“…Thus, studies assessing shorter term use, use at older age or use during short windows prior to disease onset, may be missing the most relevant time frames for arresting the inflammatory process. For example, this might explain the failure to detect a protective effect in some studies [26,29]. Evaluating current use is especially problematic when studying NSAID use in the context of PD since the preclinical phase of PD is estimated to be long [33,34] and cases may increase pain reliever use in the years leading up to actual diagnosis as a result of preclinical PD.…”

“…An important feature determining the informativeness of studies is sample size, and some previous studies reporting no association or inconclusive results had little power to detect even a moderately sized association [26,27]. Interesting and often necessary subgroup analyses and lagging (truncating) NSAID use both further reduce study power.…”