A study recently published in JAMA Ophthalmology conducted a secondary analysis to assess the impact of long-term daily aspirin use on age-related macular degeneration (AMD).
Give me some background first.
Despite the 2023 FDA approvals of two therapeutics for treating geographic atrophy secondary to AMD, there is still no treatment for early AMD.
Even further: apart from lifestyle advice, there is no intervention that delays the progression of the disease.
Enter: Aspirin and its anti-inflammatory properties.
- The AMD connection: Investigators have noted that inflammation is a likely part of the AMD pathogenesis—thus, they sought to determine the impact of long-term low-dose aspirin on AMD, including incidence and progression.
Now, talk about the study.
This study was a subset of the ASPirin in Reducing Events in the Elderly (ASPREE) trial, focused solely on the effect of aspirin on AMD.
The original ASPREE trial was a large double-masked, placebo-controlled trial, conducted from 2014 to 2018, that investigated if low-dose aspirin could prolong disability-free survival among older individuals.
This substudy’s name: ASPirin in Reducing Events in the Elderly–AMD (ASPREE-AMD)
Talk about the participants.
Participants for ASPREE-AMD were pulled from the Australian component of ASPREE study and all had the following characteristics:
- Aged 70+
- Without dementia
- Without independence-limiting physical disability
- Without cardiovascular disease
- Without chronic illness limiting 5-year survival
- With gradable retinal images at baseline (high enough quality to assess)
A total of 3,171 participants were eventually analyzed in ASPREE-AMD.
And how were they randomized?
Participants were randomized in a block randomization procedure to receive either a placebo or 100 mg of aspirin per day, after which retinal follow-up was conducted.
- Aspirin group: 1,619
- Placebo group: 1,552
The study had 3-year and 5-year follow-up periods that differing numbers of patients participated in, leading to some varying whole group totals at stages in the findings.
Note: The authors did not provide reasoning for these varying participation numbers.
Findings?
Sex distribution was even among the patients, with a median of 73.5 years and median follow-up time of 3.1 years.
Incidence of AMD was 19.4% in the aspirin group (195/1,004) and 19.1% in the placebo group (187/979).
Tell me more.
AMD progression was also similar between the two groups:The aspirin group saw a cumulative progression of 2.3% (14/615), while the placebo group had a progression of 3.1% (18/573).
Expert opinion?
Per the authors of the study, “In this trial, low-dose aspirin administered for 3 years did not affect the incidence of AMD. The evidence was weaker for progression of AMD due to low number of progressed cases.”
They also noted that there was no evidence of harmful effects from low-dose aspirin on AMD development.
Take home.
Ultimately, this study showcases no association, as the study authors concluded: “Overall, these results do not support suggestion that low-dose daily aspirin prevents the development or progression of AMD.”