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A Randomized, Double-Blind, Study of Rofecoxib in Patients with Mild Cognitive Impairment
Abstract
Inflammatory mechanisms have been implicated in Alzheimer's disease (AD) and might be mediated via the COX-2 enzyme. Previous studies with the selective COX-2 inhibitors, rofecoxib and celecoxib, have shown that they do not alter the progression of AD. We conducted a double-blind study to investigate whether rofecoxib could delay a diagnosis of AD in patients with mild cognitive impairment (MCI), a group with an expected annual AD diagnosis rate of 10-15%. MCI patients > or =65 years were randomized to rofecoxib 25 mg (N=725) or placebo (N=732) daily for up to 4 years. The primary end point was the percentage of patients with a clinical diagnosis of AD. The estimated annual AD diagnosis rate was lower than the anticipated 10-15%: 6.4% in the rofecoxib group vs 4.5% in the placebo group (rofecoxib : placebo hazard ratio=1.46 (95% CI: 1.09, 1.94), p=0.011). Analyses of secondary end points, including measures of cognition (eg the cognitive subscale of the AD Assessment Scale (ADAS-Cog)) and global function (eg the Clinical Dementia Rating (CDR)), did not demonstrate differences between treatment groups. There was also no consistent evidence that rofecoxib differed from placebo in post hoc analyses comparing ADAS-Cog and CDR-sum of boxes scores in overlapping subgroups of patients who had Mini Mental State Exam scores of 24-26 in the present MCI study and in a previous AD treatment study with a similar design. The results from this MCI study did not support the hypothesis that rofecoxib would delay a diagnosis of AD. In conjunction with the lack of effects observed in previous AD studies, the findings suggest that inhibition of COX-2 is not a useful therapeutic approach in AD.
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“Unexpectedly, clinical trials targeting inflammation with NSAIDs have not improved cognition in AD patients [111, 112].”
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Metadata
- Authors
- on behalf of the Rofecoxib Protocol 078 study group, Thal, L. J., Ferris, S. H., Kirby, L., Block, G. A., Lines, C. R., Yuen, E., Assaid, C., Nessly, M. L., Norman, B. A., Baranak, C. C., & Reines, S. A.
- Affiliations
- University of California San Diego (US)
- New York University (US)
- Merck & Co., Inc., Rahway, NJ, USA (United States) (US)
- Corresponding author
- Lines, Christopher R
- ORCID
- Ferris, Steven H
- Venue
- Neuropsychopharmacology
- Published
- 2005-03-02
- Volume
- 30
- Issue
- 6
- Pages
- 1204-1215
- ISSN
- 0893-133X (ISSN-L)
- 1740-634X
- OpenAlex
- W2051776695
- Cited by
- 402
- References
- 51
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 6 · 2023: 15 · 2022: 16 · 2021: 16 · 2020: 6 · 2019: 12 · 2018: 14 · 2017: 19 · 2016: 15 · 2015: 20 · 2014: 13 · 2013: 14 · 2012: 24
- FWCI
- 21.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Neuropsychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- University of Rochester
- Dartmouth College
- Towson University
- York University
- University of Illinois at Urbana-Champaign
- School of Medicine, New York University
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Pharmacology (medical) › Inflammatory mediators and NSAID effects
- Keywords
- rofecoxib, mild cognitive impairment, Alzheimer's disease, COX-2 inhibitors, COX-2 inhibition, disease progression, anti-inflammatory therapy
- MeSH terms
- Aged, Cognition Disorders, Dementia, Double-Blind Method, Female, Humans, Lactones, Male, Membrane Proteins, Neuropsychological Tests, Prostaglandin-Endoperoxide Synthases, Psychiatric Status Rating Scales, Sulfones, Cyclooxygenase Inhibitors, Disease Progression, Cyclooxygenase 2, Cyclooxygenase 2 Inhibitors
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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What counts as a claim ›How we measure confidence ›How we check this ›
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