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Re-orient Alzheimer treatment, favor cognitive approach ?

Updated: Mar 24, 2020

With 50 million patients globally and no disease-modifying treatment, Alzheimer's disease represents a major unmet need. Following multiple R&D failures and early successes in detection and cognitive approach, it might be time to re-orient efforts and investments.


50 million people worldwide suffer from Alzheimer's disease today, and global prevalence is expected to grow to 150 million by 2050. Economic impact in US only was $259 billion in 2017. Nevertheless, despite huge investments, no major treatment has been approved since 2003. Why is that, and what to do ?


DIVERSIFY PHARMA R&D

Last March, Biogen and Eisai shocked the world by halting major Phase III trials on Aducanumab which targeted β-amyloid plaques. This was a terrible disappointment for Alzheimer’s patients and the medical community. Following repeated failures in this area (Roche and AC Immune's Crenezumab, Pfizer and J&J’s Bapineuzumab, Merck's Verubecestat, Eli Lilly & Co.’s Solanezumab...) it is probably time to accelerate non-amyloid strategies.

Although amyloid plaques are linked to Alzheimer's disease, they might not be causing it.

Targeting Tau-proteins, which can misfold with age, is addressed by Roche's Gantenerumab and Abbvie ABBV-8E12, among others. Targeting mitochondria, which can become impaired with age possibly causing Alzheimer’s is another promising approach. Other studies such as INmune Bio's Phase I on XPro1595, target Alzheimer’s-related inflammation. A link to gum disease bacteria is even being investigated by Cortexyme.


FOCUS ON EARLY DETECTION AND COGNITIVE APPROACH

A promising approach is to focus on early detection and favor cognitive treatments.

Combining Blood Test With Genetic Screening has recently shown 94% detection accuracy, at a much lower cost than the typical price of a PET scan.

Orientation techniques and virtual reality have shown promising results in helping dementia patients recall memories.

Initial results from a study by Eli Lilly, Apple and Evidation Health, showed that a combination of smartphones, smartwatches and mobile apps could potentially help spot people with mild cognitive impairment or mild dementia related to Alzheimer’s. Study was performed on 113 participants over 12 weeks in real-world settings.


COMBINE MULTIPLE STRATEGIES

What we call Alzheimer’s disease might stem from several different causes, so exploring multiple diagnostic, pharma and device strategies is probably the best approach.


It is also critically needed for millions of current and future patients.


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