Angiotensin-converting enzyme inhibitors and motor neuron disease: An unconfirmed association

Abstract

Objective: To investigate the association between angiotensin converting enzyme inhibitors (ACEIs), angiotensin II receptors blockers (ARBs) and motor neuron disease (MND).

Methods: This is a population-based nested case-control study. Data were obtained from a population registry and the administrative database of the Lombardy Region (Northern Italy) from 2000 through 2010. Included were 1,200 patients with newly diagnosed MND/ALS and 120,000 controls, randomly selected from the same population and matched for gender, age and area of residence.

Exposure to ACEIs or ARBs was quantified using defined daily doses (DDDs). Cumulative DDD (cDDD) was estimated as the sum of dispensed DDDs in the preceding 5 years, excluding 1 year before the MND/ALS diagnosis. Overall exposure, levels of exposure, and individual drugs were all assessed. Subgroup analyses were performed according to age, sex, ALS and ACEI-ARB association.

Results: There was no significant association between MND/ALS and antecedent use of ACEIs or ARBs. Data were confirmed in multivariable models and in subgroups.

Conclusions: A protective role of ACEIs and ARBs in MND was not confirmed. Differences with a previous report (showing an inverse association between ACEIs and ALS) can be explained by different genetic background, dietary habits and susceptibility to environmental exposures, including drugs.

Keywords:

• Drugs
• Angiotensin-Converting Enzyme Inhibitors
• Angiotens in Receptor Blockers (ARB)
• motor neuron disease
• administrative data

Acknowledgements

This study was supported by grants from the Region Health Ministry of the Lombardy Region (Progetto ‘Epidemiologia dei Farmaci’ – EPIFARM).

The authors are indebted with Ms. Susanna Franceschi for typing the manuscript.

Declaration of interest

EBe serves on the editorial boards of Amyotrophic Lateral Sclerosis, Clinical Neurology & Neurosurgery, and Neuroepidemiology; has been an associate editor of Epilepsia; has received money for board membership from VIROPHARMA and EISAI; has received funding for travel and speaker honoraria from UCB-Pharma, Sanofi-Aventis, GSK; has received funding for educational presentations from GSK and grants from the Italian Drug Agency and from the Italian Ministry of Health. The remaining authors have nothing to disclose.