ACE inhibitors give ALS patients 57% longer symptom-free periods

In patients with amyotrophic lateral sclerosis (ALS), consistency in taking prescribed ACE inhibitors (ACEIs) may result in slowing disease progression.

A case-control study on ALS patients published online Nov. 10 in JAMA: Neurology found that patients who were most consistent over the course of four years in taking ACEIs had the best prognosis compared with patients who were less consistent or who were not prescribed ACEIs. ALS, also known as Lou Gehrig’s disease, is a motor neuron disease that affects approximately 3.9 persons for every 1,000 in the U.S. with survival between three to five years following symptom onset.

Feng-Cheng Lin, MD, of the department of neurology at Kaohsiung Medical University Hospital in Kaohsiung, Taiwan, and colleagues looked at patients with medically certified cases of ALS in the Taiwanese National Health Insurance system. They acquired 729 new ALS cases between 2002 and 2008 for the study and compared outcomes with matched control individuals through the same system. Cumulative defined daily doses of ACEIs, other antihypertensives, aspirin, steroids and nonsteroidal anti-inflammatory drugs were analyzed as treatments for ALS.

The best outcomes, they found, generally occurred with ACEI use. Patients who were most consistent with their daily dose of ACEIs had a 57 percent longer latency period when compared to patients who were not taking them. Patients who were less consistent saw only marginal improvement in disease progression.  

For patients taking ACEIs, the best cumulative defined daily dose was 449.5 or more. Still, consistency was key with any drug regimen in keeping symptoms and disease progression at bay.

These findings were in keeping with studies on other progressive neurological diseases treated with ACEIs and in mouse studies where microgliosis and astrocytes were reduced when treated with the drug family.

Lin et al noted that captopril and enalapril, two ACEI-class drugs, “also had potential protective effects on ALS risk.” They noted these two drugs specifically appeared to reduce patient risk for ALS significantly.

However, Lin et al recommended that for any drug, especially ACEIs, aspirin and vitamin E, future focused clinical trials be conducted to determine long-term outcomes for patients with ALS diagnoses.