Prospects Dim for Daily Aspirin As a Way to Protect Retina Health

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Some large randomized trials have suggested that taking low doses of aspirin on a daily basis would be an easy, inexpensive way of lowering the risk of getting age-related macular degeneration. Not so a well-designed, placebo-controlled study of septuagenarians conducted in Australia.

There’s plenty of evidence that inflammation and particularly the complement system play an important role in cause age-related macular degeneration. The FDA has approved two drugs, Syfovre (pegcetacoplan) and Izervay (avacincaptad pegol) as treatments for geographic atrophy, an advanced form of age-related macular degeneration (AMD) and both block aspects of the complement system.

No one is proposing that aspirin, which has anti-inflammatory properties, be used to treat age-related macular degeneration. But two large, randomized trials, the Physicians’ Health Study and the Women’s Health Study, have produced results that taking low doses of aspirin might have a protected effect against getting the eye condition in the first place. But the evidence is far from clear cut, and researchers are still conducting studies to figure out whether aspirin might preserve retinal health.

Liubov D. Robman, M.B.B.S., Ph.D.

Liubov D. Robman, M.B.B.S., Ph.D.

Results reported in JAMA Ophthalmology last week were not encouraging. Liubov D. Robman, M.B.B.S., Ph.D., of School of Public Health and Preventive Medicine at Monash University in Melbourne, Australia, and her colleagues found no difference in the incidence of AMD between older people (median [IQR] age of 73.5) who were randomly assigned to take 100 milligrams of enteric-coated aspirin daily and a placebo. After three years of follow-up, 195 of the 1,004 (19.4%) of the study participants in the aspirin group developed AMD while nearly the same proportion — 187 of 979 (19.1%) — of those assigned to the placebo group developed the eye condition.

The results were a substudy of the Aspirin in Reducing Events in the Elderly (ASPREE) trial, a prevention trial conducted in Australia and the United States that was designed to discover whether small, daily doses of aspirin could have broad health effects, lengthening the healthy life span of older adults. By and large, the ASPREE haven’t shown a benefit from aspirin. In fact, one standout finding is that low-dose aspirin resulted in higher risk of bleeding and did not reduce the risk of cardiovascular disease.

Robman and colleagues noted that the positive results for aspirin in other retina studies were based on self-reported AMD whereas the ASPREE study results used the grading of color images of the retina and a database of treatment with anti-vascular endothelial growth factor.

The ASPREE study had 16,703 Australian participants, of whom 5,422 agree to retinal images. About 400 participants had poor quality retinal images or the imaging was done after a deadline, leaving a group of 4,933. The participants had baseline retinal image taken during a five-year span between March 2020 and January 2015 and then images taken three and five years after they were randomly assigned to the aspirin group or the placebo. Both the participants and the people dealingwith the participants were masked about whether they were receiving aspirin or placebo.

The researchers also looked to see if aspirin affected the progression from early-intermediate AMD to late AMD. The results hint of some benefit but the number of participants was small so the results did not reach statistical significance.

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