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Efectos del rofecoxib o el naproxeno frente al placebo en la progresión de la enfermedad de Alzheimer: un ensayo
Paul S Aisen1, Kimberly A Schafer, Michael Grundman
1Department of Neurology, Georgetown University Medical Center, Washington, DC 20057, USA. psa@georgetown.edu
JAMA
|June 5, 2003
Resumen
Los medicamentos antiinflamatorios no esteroideos (AINE) como el naproxeno y el rofecoxib no ralentizaron el deterioro cognitivo en pacientes con enfermedad de Alzheimer (EA) durante un año. El estudio no encontró diferencias significativas en la función cognitiva en comparación con el placebo.
Área de la Ciencia:
- La neurociencia es la neurociencia.
- Farmacología Farmacología.
- La medicina clínica es la medicina clínica.
Sus antecedentes:
- Los mecanismos inflamatorios están implicados en la lesión neuronal en la enfermedad de Alzheimer (EA).
- Se supone que los medicamentos antiinflamatorios no esteroideos (AINE) pueden modificar potencialmente la progresión de la EA debido a sus propiedades antiinflamatorias.
Objetivo del estudio:
- Evaluar si la administración de inhibidores selectivos de la ciclooxigenasa (COX) - 2 (rofecoxib) o de AINE no selectivos tradicionales (naproxeno) ralentiza el deterioro cognitivo en pacientes con EA de leve a moderada.
- Evaluar la seguridad y eficacia de estos AINE en la población de EA.
Principales métodos:
- Un ensayo multicéntrico, aleatorizado, doble ciego, controlado con placebo que involucró a 351 participantes con EA de leve a moderada.
- Los participantes recibieron diariamente rofecoxib (25 mg), naproxeno sódico (220 mg dos veces al día) o placebo durante un año.
- El deterioro cognitivo se midió principalmente por el cambio de 1 año en la puntuación de la subescala de la Escala de Evaluación de la Enfermedad de Alzheimer-Cognitiva (ADAS-Cog).
Principales resultados:
- Ni el naproxeno ni el rofecoxib demostraron una diferencia significativa en la desaceleración del deterioro cognitivo (puntuaciones de ADAS-Cog) en comparación con el placebo después de un año.
- Las medidas de resultado secundarias tampoco mostraron beneficios consistentes para ninguno de los grupos de tratamiento activo.
- Se observó una mayor incidencia de fatiga, mareos, hipertensión y eventos adversos más graves en los grupos de fármacos activos en comparación con el placebo.
Conclusiones:
- El rofecoxib y la dosis baja de naproxeno no parecen retardar el deterioro cognitivo en pacientes con enfermedad de Alzheimer de leve a moderada.
- Los hallazgos no apoyan el uso de estos AINE para modificar el curso del deterioro cognitivo en la enfermedad de Alzheimer.
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