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Review
. 2010 Mar 23;74(12):995-1002.
doi: 10.1212/WNL.0b013e3181d5a4a3.

Anti-inflammatory drugs and risk of Parkinson disease: a meta-analysis

Joshua J Gagne  1 , Melinda C Power
Affiliations
Review

Anti-inflammatory drugs and risk of Parkinson disease: a meta-analysis

Joshua J Gagne et al. Neurology. .

Abstract

Background/objective: Anti-inflammatory drugs may prevent Parkinson disease (PD) by inhibiting a putative underlying neuroinflammatory process. We tested the hypothesis that anti-inflammatory drugs reduce PD incidence and that there are differential effects by type of anti-inflammatory, duration of use, or intensity of use.

Methods: MEDLINE and EMBASE were searched for studies that reported risk of PD associated with anti-inflammatory medications. Random-effects meta-analyses were used to pool results across studies for each type of anti-inflammatory drug. Stratified meta-analyses were used to assess duration- and intensity-response.

Results: Seven studies were identified that met the inclusion criteria, all of which reported associations between nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) and PD, 6 of which reported on aspirin, and 2 of which reported on acetaminophen. Overall, a 15% reduction in PD incidence was observed among users of nonaspirin NSAIDS (relative risk [RR] 0.85, 95% confidence interval [CI] 0.77-0.94), with a similar effect observed for ibuprofen use. The protective effect of nonaspirin NSAIDs was more pronounced among regular users (RR 0.71, 95% CI 0.58-0.89) and long-term users (RR 0.79, 95% CI 0.59-1.07). No protective effect was observed for aspirin (RR 1.08, 95% CI 0.92-1.27) or acetaminophen (RR 1.06, 95% CI 0.87-1.30). Sensitivity analyses found results to be robust.

Conclusions: There may be a protective effect of nonaspirin nonsteroidal anti-inflammatory drug use on risk of Parkinson disease (PD) consistent with a possible neuroinflammatory pathway in PD pathogenesis.

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Figures

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Figure 1 Flow diagram of study selection
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Figure 2 Relative risks (95% confidence intervals [CI]) from studies of nonaspirin nonsteroidal anti-inflammatory drug use and effect of Parkinson disease
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Figure 3 Risk of Parkinson disease associated with nonaspirin nonsteroidal anti-inflammatory drug use stratified by duration, intensity, and type of use *Rx only and Rx and OTC denote whether exposure definition included prescription (Rx) nonsteroidal anti-inflammatory drug (NSAID) use or both prescription and over-the-counter (OTC) NSAID use. CI = confidence interval.
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Figure 4 Relative risks (95% confidence intervals [CI]) from studies of aspirin use and effect on Parkinson disease
See this image and copyright information in PMC

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