NSAID’s and Alzheimer’s Disease

celebrex

A research paper recently published is the strongest link yet between NSAID’s like Celebrex and Alzheimer’s disease (AD). NSAID’s have become standard fare in the medical community.   Any patient who has any type of musculoskeletal disorder gets them.  The above study shows a strong link between this drug and AD in more than 2,700 patients followed for 12 years.  The newer drugs like Celbrex also increase your risk of sudden death.  This is directly from Pfizer’s web-site:

The following adverse reactions occurred in 0.1 – 1.9% of patients treated with CELEBREX (100 – 200 mg twice daily or 200 mg once daily):

Cardiovascular: Aggravated hypertension, angina pectoris, coronary artery disorder, myocardial infarction

Myocardial infarction in about 1 in 100 patients?  Can you imagine if 1 in 100 patients receiving a very common medical procedure like an injection in a doctor’s office were at risk for an MI?  That procedure would immediately cease.  How much does Celebrex increase your cardiac risk?  The studies generally show that this risk is elevated approximately 2.5 times by this drug.  To put in perspective, we all know that a patient with diabetes is at higher risk for heart disease.  Celebrex increases your cardiac risk about the same as if you were diagnosed with diabetes (for males this about doubles your cardiac risk).

How about the study showing that NSAID’s when taken for 60 days or more are associated with a 1 in 1,200 death rate (usually due to a GI bleed)? Let’s digest the author’s conclusion:

“On average 1 in 1200 patients taking NSAIDs for at least 2 months will die from gastroduodenal complications who would not have died had they not taken NSAIDs. This extrapolates to about 2000 deaths each year in the UK.”

In conclusion, in my opinion, the data supports that NSAID’s are high risk drugs.  Comparing their relative risks to common medical procedures is very helpful.  If there was a common surgery that had a mortality risk of 1 in 1,200 and an MI risk of 1 in 100, it would be considered too risky to undertake in all but the most dire circumstances.  While these risks might be considered acceptable for surgeries that are potentially life saving or have tremendous possible benefits in a person otherwise disabled by their disease, they are not appropriate for a medication class that is used everyday in common clinical practice.  As a result, we have stopped using this drug class and will only prescribe it under very unique circumstances.  The Alzheimer’s risk?  Yep, that’s there too.  I also didn’t mention that in our experience they dramatically reduce mesenchymal stem cell proliferation, but that’s another story.

If NSAID’s won’t work, what do we recommend as anti-inflammatories.  Joe Maroon, M.D. a noted neurosurgeon at UMPC did an excellent study showing that high quality Omega 3 fish oilds allowed about 60% of his patients to get off NSAID’s. I’m a believer, as I routinely use these to manage any chronic inflammatory condition.

The upshot-avoid NSAID’s, stock up on fish oils!

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