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From the Department of Neurology (Dr. Aisen), Georgetown University Medical Center, Washington, DC; the Department of Psychiatry (Dr. Davis), Mount Sinai Medical Center, New York, NY; the Alzheimer’s Disease Cooperative Study (J.D. Berg, K. Schafer, and K. Campbell) and the Departments of Family and Preventive Medicine (Dr. Thomas) and Neurosciences (Drs. Grundman and Thal), University of California at San Diego; the Department of Psychiatry (Dr. Weiner), University of Texas Southwestern Medical Center, Dallas, TX; the Department of Neurology (Dr. Farlow), Indiana University Hospital, Indianapolis, IN; and the Gertrude H. Sergievsky Center (Dr. Sano), Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY.
Address correspondence and reprint requests to Dr. Paul S. Aisen, Department of Neurology, Georgetown University Medical Center, 1 Bles Building, 3800 Reservoir Road, N.W., Washington, DC 20007.
BACKGROUND: Laboratory and epidemiologic studies suggest that anti-inflammatory/immunosuppressive therapy may be useful in the treatment of AD. In preliminary studies, a regimen of low to moderate dose prednisone was found to suppress peripheral inflammatory markers without adverse effects in subjects with AD.
METHODS: We conducted a randomized, placebo-controlled multicenter trial to determine whether prednisone treatment slowed the rate of cognitive decline in AD. The active treatment regimen consisted of an initial dose of 20 mg of prednisone daily for 4 weeks tapered to a maintenance dose of 10 mg daily for 1 year, followed by gradual withdrawal during an additional 16 weeks. The primary outcome measure was the 1-year change in the cognitive subscale of the AD Assessment Scale.
RESULTS: A total of 138 subjects were randomized to the drug and placebo groups. There was no difference in cognitive decline between the prednisone and placebo treatment groups in the primary intent-to-treat analysis, or in a secondary analysis considering completers only. Subjects treated with prednisone showed behavioral decline compared with those in the placebo group.
CONCLUSION: A low-dose regimen of prednisone is not useful in the treatment of AD.
Key words: AD—Anti-inflammatory therapy—Glucocorticoids—Randomized controlled trial
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