Increasing evidence suggests that inflammation may play a role in neurodegenerative conditions like Parkinson disease (PD) and that reducing inflammation with nonsteroidal anti-inflammatory drugs (NSAIDs) might reduce this risk. In this prospective study, researchers assessed the PD risk associated specifically with ibuprofen use, compared with use of other NSAIDs, acetaminophen, or aspirin. A total of 136,197 participants from two longitudinal cohorts (the Health Professionals Follow-Up Study and the Nurses' Health Study) who were free of PD at baseline completed questionnaires on use of these drugs every 2 years. During 6 years of follow-up, 291 participants developed PD. Individuals who consumed ibuprofen, but not other NSAIDs, aspirin, or acetaminophen, had a significantly (40%) lower risk for PD. The dose-response trend was significant. The association remained significant in analyses adjusted for potential confounding factors (age, smoking, body-mass index, ibuprofen use within 2 years before PD diagnosis, and intake of lactose, alcohol, and caffeine) and after excluding individuals with histories of gout. The prospective nature of the study and the high participation rates minimized the recall and selection bias that are often seen in cohort studies. In a meta-analysis of all published prospective studies assessing ibuprofen use specifically, the PD risk reduction (27%) was still significant. Comment: These findings suggest that ibuprofen, but not other NSAIDs, might reduce PD risk. Why the differential effect? The authors cite evidence that not all NSAIDs have similar mechanisms of action and that ibuprofen uniquely binds to a specific ligand that acts as an inhibitor of apoptosis and oxidative damage. As editorialists note, this type of association doesn't prove causation but adds to the growing body of evidence that specific inflammatory factors likely play a role in PD. Clinical trials are now needed to determine if ibuprofen can slow disease progression in patients with PD, but care is needed, as long-term daily use of ibuprofen is not without risks. Given the very low risk for PD in the general population, the risks of long-term ibuprofen couldn't be justified for primary prevention. By : David A. Grimes, MD, FRCPC Source : Journal Watch Specialties
