Prevention, Treatment, and Cost-Minimization in Alzheimer’s Disease Care

A comprehensive presentation on the diagnosis, treatment, and prevention of Alzheimer’s disease was recently given at AMCP Nexus 2019.

Regarding the emerging Alzheimer’s therapies, the authors noted that there are currently over 100 being tested in humans. These drugs include amyloid and tau protein modulating drugs and biologics, chemical messenger-based drugs, drugs emphasizing neuroprotection, and nutraceuticals.

They explained that amyloid plaques are character to the disease, noting that rare causes of familial Alzheimer’s all involve conflicts with amyloid processing. There is, however, a rare mutation that blocks the pathological amyloid cascade and prevents the disease according to the authors, presenting a potential target for treatments.

According to the authors, previous trials of amyloid-based therapies for Alzheimer’s disease include active and passive immunization, β-secretase and γ-secretase inhibitors (“BACE” inhibitors), and anti-aggregation therapies, however, these attempts have failed for various reasons. The authors also note that passive and active immunotherapies are at the center of ongoing studies targeting amyloid. They also noted that nutraceuticals are not regulated by the FDA and that unsubstantiated claims are common. Most of these treatments have failed when tested in Alzheimer’s patients, including ginkgo biloba, various vitamins, DHA, and other agents.

Notable developments in this research process included the SPRINT Memory and Cognition IN Decreased Hypertension (MIND) study, a randomized clinical trial comparing two strategies for managing hypertension. The two groups in this study are the intensive strategy group (systolic blood pressure goal < 120 mm Hg) and the standard care group (systolic blood pressure < 140 mm Hg). This work has found significant reductions in the risk of MCI and MCI/dementia in the intensive strategy group compared to the standard care group. It is the first trial to demonstrate a reduction in MCI incidence and MCI/dementia.

The researchers went on to address various value-based payment arrangements for early-stage Alzheimer’s disease treatments. Many drugs currently being researched are targeting early-stage disease, with 7 phase III prevention trials and 26 phase III trials targeting MCI/mild stages are underway. There are also 99 drugs in phase II and III testing, with 74 being disease-modifying treatments that target disease pathology.

The team noted that treating dementia earlier would shift costs to much earlier in the patient’s disease progression. Preventative care was also discussed, with prevention trials aiming to minimize cognitive impairment in patients.

 

Presentation:

Tariot, P, Schneider, M, et al. Preventative Treatment for Alzheimer’s Disease and the Future Role of Value-Based Payment Arrangements. Presented at: AMCP Nexus 2019; October 29 – Nov 1; National Harbor, MD.