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April 30, 2019; 92 (18) Null HypothesisOpen Access

INTREPAD

A randomized trial of naproxen to slow progress of presymptomatic Alzheimer disease

Pierre-François Meyer, Jennifer Tremblay-Mercier, Jeannie Leoutsakos, Cécile Madjar, Marie-Élyse Lafaille-Maignan, Melissa Savard, View ORCID ProfilePedro Rosa-Neto, Judes Poirier, Pierre Etienne, John Breitner, for the PREVENT-AD Research Group
First published April 5, 2019, DOI: https://doi.org/10.1212/WNL.0000000000007232
Pierre-François Meyer
From the McGill Centre for Integrative Neuroscience, Montreal Neurological Institute (C.M.), and McGill University Research Centre for Studies in Aging (M.S., P.R.-N.), McGill University (P.-F.M., M.-E.L.-M., P.R.-N., J.P., P.E., J.B.); StoP-AD Centre (P.-F.M., J.T.-M., M.-E.L.-M., P.R.-N., J.P., P.E., J.B.), Douglas Mental Health University Institute Research Centre, Montréal, Canada; and John Hopkins University (J.L.), Baltimore, MD.
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Jennifer Tremblay-Mercier
From the McGill Centre for Integrative Neuroscience, Montreal Neurological Institute (C.M.), and McGill University Research Centre for Studies in Aging (M.S., P.R.-N.), McGill University (P.-F.M., M.-E.L.-M., P.R.-N., J.P., P.E., J.B.); StoP-AD Centre (P.-F.M., J.T.-M., M.-E.L.-M., P.R.-N., J.P., P.E., J.B.), Douglas Mental Health University Institute Research Centre, Montréal, Canada; and John Hopkins University (J.L.), Baltimore, MD.
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Jeannie Leoutsakos
From the McGill Centre for Integrative Neuroscience, Montreal Neurological Institute (C.M.), and McGill University Research Centre for Studies in Aging (M.S., P.R.-N.), McGill University (P.-F.M., M.-E.L.-M., P.R.-N., J.P., P.E., J.B.); StoP-AD Centre (P.-F.M., J.T.-M., M.-E.L.-M., P.R.-N., J.P., P.E., J.B.), Douglas Mental Health University Institute Research Centre, Montréal, Canada; and John Hopkins University (J.L.), Baltimore, MD.
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Cécile Madjar
From the McGill Centre for Integrative Neuroscience, Montreal Neurological Institute (C.M.), and McGill University Research Centre for Studies in Aging (M.S., P.R.-N.), McGill University (P.-F.M., M.-E.L.-M., P.R.-N., J.P., P.E., J.B.); StoP-AD Centre (P.-F.M., J.T.-M., M.-E.L.-M., P.R.-N., J.P., P.E., J.B.), Douglas Mental Health University Institute Research Centre, Montréal, Canada; and John Hopkins University (J.L.), Baltimore, MD.
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Marie-Élyse Lafaille-Maignan
From the McGill Centre for Integrative Neuroscience, Montreal Neurological Institute (C.M.), and McGill University Research Centre for Studies in Aging (M.S., P.R.-N.), McGill University (P.-F.M., M.-E.L.-M., P.R.-N., J.P., P.E., J.B.); StoP-AD Centre (P.-F.M., J.T.-M., M.-E.L.-M., P.R.-N., J.P., P.E., J.B.), Douglas Mental Health University Institute Research Centre, Montréal, Canada; and John Hopkins University (J.L.), Baltimore, MD.
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Melissa Savard
From the McGill Centre for Integrative Neuroscience, Montreal Neurological Institute (C.M.), and McGill University Research Centre for Studies in Aging (M.S., P.R.-N.), McGill University (P.-F.M., M.-E.L.-M., P.R.-N., J.P., P.E., J.B.); StoP-AD Centre (P.-F.M., J.T.-M., M.-E.L.-M., P.R.-N., J.P., P.E., J.B.), Douglas Mental Health University Institute Research Centre, Montréal, Canada; and John Hopkins University (J.L.), Baltimore, MD.
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Pedro Rosa-Neto
From the McGill Centre for Integrative Neuroscience, Montreal Neurological Institute (C.M.), and McGill University Research Centre for Studies in Aging (M.S., P.R.-N.), McGill University (P.-F.M., M.-E.L.-M., P.R.-N., J.P., P.E., J.B.); StoP-AD Centre (P.-F.M., J.T.-M., M.-E.L.-M., P.R.-N., J.P., P.E., J.B.), Douglas Mental Health University Institute Research Centre, Montréal, Canada; and John Hopkins University (J.L.), Baltimore, MD.
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  • ORCID record for Pedro Rosa-Neto
Judes Poirier
From the McGill Centre for Integrative Neuroscience, Montreal Neurological Institute (C.M.), and McGill University Research Centre for Studies in Aging (M.S., P.R.-N.), McGill University (P.-F.M., M.-E.L.-M., P.R.-N., J.P., P.E., J.B.); StoP-AD Centre (P.-F.M., J.T.-M., M.-E.L.-M., P.R.-N., J.P., P.E., J.B.), Douglas Mental Health University Institute Research Centre, Montréal, Canada; and John Hopkins University (J.L.), Baltimore, MD.
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Pierre Etienne
From the McGill Centre for Integrative Neuroscience, Montreal Neurological Institute (C.M.), and McGill University Research Centre for Studies in Aging (M.S., P.R.-N.), McGill University (P.-F.M., M.-E.L.-M., P.R.-N., J.P., P.E., J.B.); StoP-AD Centre (P.-F.M., J.T.-M., M.-E.L.-M., P.R.-N., J.P., P.E., J.B.), Douglas Mental Health University Institute Research Centre, Montréal, Canada; and John Hopkins University (J.L.), Baltimore, MD.
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John Breitner
From the McGill Centre for Integrative Neuroscience, Montreal Neurological Institute (C.M.), and McGill University Research Centre for Studies in Aging (M.S., P.R.-N.), McGill University (P.-F.M., M.-E.L.-M., P.R.-N., J.P., P.E., J.B.); StoP-AD Centre (P.-F.M., J.T.-M., M.-E.L.-M., P.R.-N., J.P., P.E., J.B.), Douglas Mental Health University Institute Research Centre, Montréal, Canada; and John Hopkins University (J.L.), Baltimore, MD.
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From the McGill Centre for Integrative Neuroscience, Montreal Neurological Institute (C.M.), and McGill University Research Centre for Studies in Aging (M.S., P.R.-N.), McGill University (P.-F.M., M.-E.L.-M., P.R.-N., J.P., P.E., J.B.); StoP-AD Centre (P.-F.M., J.T.-M., M.-E.L.-M., P.R.-N., J.P., P.E., J.B.), Douglas Mental Health University Institute Research Centre, Montréal, Canada; and John Hopkins University (J.L.), Baltimore, MD.
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INTREPAD
A randomized trial of naproxen to slow progress of presymptomatic Alzheimer disease
Pierre-François Meyer, Jennifer Tremblay-Mercier, Jeannie Leoutsakos, Cécile Madjar, Marie-Élyse Lafaille-Maignan, Melissa Savard, Pedro Rosa-Neto, Judes Poirier, Pierre Etienne, John Breitner, for the PREVENT-AD Research Group
Neurology Apr 2019, 92 (18) e2070-e2080; DOI: 10.1212/WNL.0000000000007232

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This article has a correction. Please see:

  • INTREPAD - August 20, 2019
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    Figure 1 Consort flow

    Fragile cognitive status indicates individuals with cognitive deficits suggestive of early mild cognitive impairment. GI = gastrointestinal; mITT = modified intent-to-treat; SAE = serious adverse event.

  • Figure 2
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    Figure 2 Trial timeline

    Full assessment (on site): baseline (BL), 3 months, 12 months, 24 months. Safety follow-up (on site): 1 month, 6 months, 18 months. Safety follow-up (telephone): 9 months, 15 months, 21 months. ** T1-weighted (EN, BL, 3 months, 12 months, 24 months), fluid-attenuated inversion recovery (EN, 24 months), diffusion-weighted imaging (EN, 24 months), arterial spin labeling (BL, 3 months, 12 months, 24 months), resting-state fMRI (BL, 3 months, 12 months, 24 months), gradient echo quantitative T2* task (BL, 3 months, 12 months, 24 months), task fMRI (BL, 3 months, 12 months, 24 months). EN = enrollment; LP = lumbar puncture; RBANS = repeatable battery for assessment of neuropsychological status; UPSIT = University of Pennsylvania Smell Identification Test.

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    Figure 3 Treatment effects on Alzheimer Progression Score (APS)

    Results for primary and exploratory secondary outcomes are represented. (A) There was no meaningful difference in APS rate of change between treatment groups. (B) Mean change from baseline (± standard error of the mean) in APS did not differ between the 2 treatment groups at any time during the treatment interval. However, APS for both groups increased after 12 and 24 months (*p < 0.05). Data are represented as point estimates (group means) with error bars (standard error of the mean). BL = Baseline; M = months.

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    Figure 4 Treatment effects on neurosensory and CSF biomarker measures

    Linear mixed effect models did not indicate any difference between naproxen- and placebo-assigned groups in rate of change of (A) cognitive or neurosensory or (B) biological markers of Alzheimer disease. University of Pennsylvania Smell Identification Test (UPSIT) scores decreased over the 2-year trial period for the whole group (*p < 0.05). Data are represented as point estimates (group means) with error bars (standard error of the mean). BL = baseline; p-tau = phosphorylated tau; RBANS = Repeatable Battery for the Assessment of Neuropsychological Status; t-tau = total tau.

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Letters: Rapid online correspondence

  • Author response: INTREPAD: A randomized trial of naproxen to slow progress of presymptomatic Alzheimer disease
    • John Breitner, geriatric psychiatrist, Douglas Hospital Research Centre
    • Pierre-Francois Meyer, PhD student, Integrated Program in Neuroscience, McGill University
    Submitted June 11, 2019
  • Reader response: INTREPAD: A randomized trial of naproxen to slow progress of presymptomatic Alzheimer disease
    • J. Wesson Ashford, Physician, Psychiatrist, and War Related Illness and Injury Study Center Director, Stanford University, VA Palo Alto Health Care System
    Submitted April 17, 2019
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