Effects of Rofecoxib or Naproxen vs Placebo on Alzheimer Disease Progression: A Randomized Controlled Trial

Paul S. Aisen, Kimberly A. Schafer, Michael Grundman, Eric Pfeiffer, Mary Sano, Kenneth L. Davis, Martin R. Farlow, Shelia Jin, Ronald G. Thomas, Leon J. Thal

Research output: Contribution to journalArticle

795 Citations (Scopus)

Abstract

Context: Laboratory evidence that inflammatory mechanisms contribute to neuronal injury in Alzheimer disease (AD), along with epidemiological evidence, suggests that nonsteroidal anti-inflammatory drugs (NSAIDs) may favorably influence the course of the disease. Objective: To determine whether treatment with a selective cyclooxygenase (COX)-2 inhibitor (rofecoxib) or a traditional nonselective NSAID (naproxen) slows cognitive decline in patients with mild-to-moderate AD. Design: Multicenter, randomized, double-blind, placebo-controlled, parallel group trial, with 1-year exposure to study medications. Setting: Forty ambulatory treatment centers affiliated with the Alzheimer's Disease Cooperative Study consortium. Participants: Participants with mild-to-moderate AD (Mini-Mental State Examination score of 13-26) were recruited from December 1999 to November 2000 using clinic populations, referrals from community physicians, and local advertising. Stable use of cholinesterase inhibitors, estrogen, low-dose aspirin, and vitamin E was allowed. Participants with inflammatory diseases that might respond to the study medications were excluded. Of 474 participants screened, 351 were enrolled. Interventions: Once-daily rofecoxib, 25 mg, or twice-daily naproxen sodium, 220 mg, or placebo. Main Outcome Measures: The primary outcome measure was the 1-year change in the Alzheimer Disease Assessment Scale-Cognitive (ADAS-Cog) subscale score. Secondary outcome measures included the Clinical Dementia Rating scale sum-of-boxes, the Neuropsychiatric Inventory, the Quality of Life-AD, and the time to attainment of significant end points (4-point decline from baseline ADAS-Cog score, 1-step worsening on the global Clinical Dementia Rating scale, 15-point decline on the ADCS activities of daily living inventory, institutionalization, or death). Results: The 1-year mean (SD) change in ADAS-Cog scores in participants treated with naproxen (5.8 [8.0]) or rofecoxib (7.6 [7.7]) was not significantly different from the change in participants treated with placebo (5.7 [8.2]). Results of secondary analyses showed no consistent benefit of either treatment. Fatigue, dizziness, and hypertension were more commonly reported in the active drug groups, and more serious adverse events were found in the active treatment group than in the placebo group. Conclusion: The results of this study indicate that rofecoxib or low-dose naproxen does not slow cognitive decline in patients with mild-to-moderate AD.

Original languageEnglish (US)
Pages (from-to)2819-2826
Number of pages8
JournalJournal of the American Medical Association
Volume289
Issue number21
DOIs
StatePublished - Jun 4 2003

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Naproxen
Disease Progression
Alzheimer Disease
Randomized Controlled Trials
Placebos
Outcome Assessment (Health Care)
Dementia
Anti-Inflammatory Agents
Pharmaceutical Preparations
rofecoxib
Equipment and Supplies
Institutionalization
Cyclooxygenase 2 Inhibitors
Cholinesterase Inhibitors
Dizziness
Therapeutics
Activities of Daily Living
Vitamin E
Aspirin
Fatigue

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Aisen, P. S., Schafer, K. A., Grundman, M., Pfeiffer, E., Sano, M., Davis, K. L., ... Thal, L. J. (2003). Effects of Rofecoxib or Naproxen vs Placebo on Alzheimer Disease Progression: A Randomized Controlled Trial. Journal of the American Medical Association, 289(21), 2819-2826. https://doi.org/10.1001/jama.289.21.2819

Effects of Rofecoxib or Naproxen vs Placebo on Alzheimer Disease Progression : A Randomized Controlled Trial. / Aisen, Paul S.; Schafer, Kimberly A.; Grundman, Michael; Pfeiffer, Eric; Sano, Mary; Davis, Kenneth L.; Farlow, Martin R.; Jin, Shelia; Thomas, Ronald G.; Thal, Leon J.

In: Journal of the American Medical Association, Vol. 289, No. 21, 04.06.2003, p. 2819-2826.

Research output: Contribution to journalArticle

Aisen, PS, Schafer, KA, Grundman, M, Pfeiffer, E, Sano, M, Davis, KL, Farlow, MR, Jin, S, Thomas, RG & Thal, LJ 2003, 'Effects of Rofecoxib or Naproxen vs Placebo on Alzheimer Disease Progression: A Randomized Controlled Trial', Journal of the American Medical Association, vol. 289, no. 21, pp. 2819-2826. https://doi.org/10.1001/jama.289.21.2819
Aisen, Paul S. ; Schafer, Kimberly A. ; Grundman, Michael ; Pfeiffer, Eric ; Sano, Mary ; Davis, Kenneth L. ; Farlow, Martin R. ; Jin, Shelia ; Thomas, Ronald G. ; Thal, Leon J. / Effects of Rofecoxib or Naproxen vs Placebo on Alzheimer Disease Progression : A Randomized Controlled Trial. In: Journal of the American Medical Association. 2003 ; Vol. 289, No. 21. pp. 2819-2826.
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AU - Schafer, Kimberly A.

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AU - Pfeiffer, Eric

AU - Sano, Mary

AU - Davis, Kenneth L.

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N2 - Context: Laboratory evidence that inflammatory mechanisms contribute to neuronal injury in Alzheimer disease (AD), along with epidemiological evidence, suggests that nonsteroidal anti-inflammatory drugs (NSAIDs) may favorably influence the course of the disease. Objective: To determine whether treatment with a selective cyclooxygenase (COX)-2 inhibitor (rofecoxib) or a traditional nonselective NSAID (naproxen) slows cognitive decline in patients with mild-to-moderate AD. Design: Multicenter, randomized, double-blind, placebo-controlled, parallel group trial, with 1-year exposure to study medications. Setting: Forty ambulatory treatment centers affiliated with the Alzheimer's Disease Cooperative Study consortium. Participants: Participants with mild-to-moderate AD (Mini-Mental State Examination score of 13-26) were recruited from December 1999 to November 2000 using clinic populations, referrals from community physicians, and local advertising. Stable use of cholinesterase inhibitors, estrogen, low-dose aspirin, and vitamin E was allowed. Participants with inflammatory diseases that might respond to the study medications were excluded. Of 474 participants screened, 351 were enrolled. Interventions: Once-daily rofecoxib, 25 mg, or twice-daily naproxen sodium, 220 mg, or placebo. Main Outcome Measures: The primary outcome measure was the 1-year change in the Alzheimer Disease Assessment Scale-Cognitive (ADAS-Cog) subscale score. Secondary outcome measures included the Clinical Dementia Rating scale sum-of-boxes, the Neuropsychiatric Inventory, the Quality of Life-AD, and the time to attainment of significant end points (4-point decline from baseline ADAS-Cog score, 1-step worsening on the global Clinical Dementia Rating scale, 15-point decline on the ADCS activities of daily living inventory, institutionalization, or death). Results: The 1-year mean (SD) change in ADAS-Cog scores in participants treated with naproxen (5.8 [8.0]) or rofecoxib (7.6 [7.7]) was not significantly different from the change in participants treated with placebo (5.7 [8.2]). Results of secondary analyses showed no consistent benefit of either treatment. Fatigue, dizziness, and hypertension were more commonly reported in the active drug groups, and more serious adverse events were found in the active treatment group than in the placebo group. Conclusion: The results of this study indicate that rofecoxib or low-dose naproxen does not slow cognitive decline in patients with mild-to-moderate AD.

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