Low-dose aspirin use ‘should not be recommended’ to prevent, treat AMD
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Key takeaways:
- Incidence of AMD was 19.4% in the aspirin group and 19.1% in the placebo group.
- Progression from early/intermediate AMD to late AMD was reported in 2.3% of the aspirin group and 3.1% of the placebo group.
In an analysis of more than 3,100 older adults, low-dose aspirin administered for 3 years did not affect the incidence or progression of age-related macular degeneration, according to study results published in JAMA Ophthalmology.
“We hoped to prove that there is an accessible, cheap and effective method of either prevention or slowing down progression of AMD,” Liubov “Luba” Robman, MBBS, PhD, a senior research fellow in the department of epidemiology and preventive medicine at Monash University in Melbourne, told Healio. “To our disappointment, we discovered that regular low-dose aspirin does not prevent the development of new AMD cases.”
To determine the effects of long-term, low-dose aspirin on the incidence and progression of AMD, Robman and colleagues conducted an Australian-based substudy of the multicenter, international, randomized, double-masked ASPREE trial, which investigated whether daily 100 mg low-dose aspirin prolonged disability-free survival in older adults.
The researchers enrolled 4,993 eligible participants, who underwent central retinal photography at baseline and at 3 years and 5 years after randomization to aspirin or placebo. Of those, 3,171 (median age, 73.5 years) were included in analysis for AMD incidence and progression, with a median follow-up time of 3.1 years.
According to results, the incidence of all AMD was 19.4% in the aspirin group and 19.1% in the placebo group (RR = 1.02; P = .86). In the aspirin group, 2.3% of participants progressed from early or intermediate AMD to late AMD compared with 3.1% in the placebo group (RR = 0.72; P = .36).
“Our study has not proven the hypothesis that aspirin may reduce AMD progression to late vision-threatening stages in a study in older adults eligible for primary prevention of cardiovascular diseases,” Robman said. “However, low-dose aspirin also did not exacerbate the progression to the advanced form of AMD — wet AMD — through its anti-platelet properties, giving some comfort for those with early or intermediate AMD who need to take aspirin for secondary prevention of cardiovascular disease.”
The researchers also reported no significant difference in the effect of low-dose aspirin on AMD incidence or progression after stratifying the population by smoking or alcohol use, sex, hypertension, BMI or use of statins.
“Regular low-dose aspirin use should not be recommended to prevent or treat AMD,” Robman told Healio.
She added, “Our clinical trial was unique in its age selection — older than 70 years — the sector of population that usually is poorly represented in large studies on eye diseases, and also in its building on the major randomized clinical trial on aspirin with its meticulous and systematic data collection. A separate ophthalmic trial of such magnitude would be prohibitively expensive. One cannot anticipate that bigger or more comprehensive research on this issue could occur in the foreseeable future.”
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