NSAIDs 'may delay or prevent onset' of Parkinson's disease
NSAIDs are associated with a reduced risk of developing Parkinson's disease (PD) and their use may delay or prevent onset of the disease, say US investigators (Arch Neurol 2003;60:1059-64).

Using data from two large cohort studies - the 14-year Health Professionals Followup of 44,057 men and the 18-year Nurses' Health Study of 98,845 women - they compared the incidence of PD in NSAID users with that in non-users. 'Use' was defined as taking an NSAID (ibuprofen, indomethacin, naproxen, diflunisal, tolmetin or sulindac) 2 or more times per week for men or in most weeks for women.

A total of 415 new cases of PD were identified. Overall, the risk of PD was reduced by half among men and women who regularly used NSAIDs (Relative risk, RR, 0.50; CI95% 0.29, 0.89, after adjustment for arthritis status). The risk declined with longer duration of NSAID use for up to 5 years. Similar analyses found that aspirin was associated with a statistically borderline risk reduction but paracetamol was not associated with a reduced risk of PD.

The investigators note that their findings support what is known about the effects of NSAIDs in experimental models of PD. An accompanying editorial suggests that the mechanism of action is probably a reduction in neuropathological inflammation secondary to COX inhibition (Arch Neurol 2003;60:1043-4). The author estimates that the number needed to treat (NNT) with NSAIDs to prevent one case of PD in 10 years is 98, which is comparable with currently established interventions such as preventing breast cancer with tamoxifen for 5 years (NNT 97).

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