Alzheimer’s: towards new modalities of care
Alzheimer is the most common neurodegenerative disease and is a source of great concern within our society. Currently, patients suffering from the condition are routinely treated with four drugs (and their generics). However, since August 1st 2018, after being deemed ineffective by the High Authority of Health (HAS), these drugs are no longer reimbursed in France. This decision, unique on a European scale, raises the question about care management of the 900,000 patients concerned [1]. The non-medicinal care available now, provides better support for patients, but the situation highlights the increased need to accelerate research to develop new curative molecules.
Lack of effective medicines
Up until now, the drug management of Alzheimer’s disease consisted in slowing down the worsening of symptoms. But according to the HAS, studies have demonstrated that medical improvements after drug therapy are minimal, even leading to significant side effects such as fractures and falls. Within the context of reducing the social security deficit, these factors led the Minister of Solidarity and Health, Agnès Buzyn, to decide to stop the reimbursement of these drugs as of August 1, 2018; highly controversial decision, as the effectiveness, despite being limited, was statistically significant, according to an “open letter” to the Minister signed by 194 doctors, neurologists, geriatricians and psychiatrists.
Towards an exclusive non-pharmacological therapy
The management of Alzheimer’s disease in France is now entirely non-drug-based, aiming to maintain patients’ physical, sensory, intellectual, psychological and social functional levels. It relies on the intervention of specialized Alzheimer teams – occupational therapists, psychomotor therapists, speech therapists, physiotherapists, psychologists, etc. – who travel to the patients’ home and provide rehabilitation care. This type of care is already well established in practice: in 2017, according to the Mederic Alzheimer [2] Foundation report, 99% of memory diagnostic sites were already prescribing nondrug treatments; nevertheless, it does not address the major challenge: treating the root of the disease.
New therapeutic approaches
In principle, disease management should remain non-drug-based until the effectiveness of new drugs has been demonstrated. The problem with this approach is that as the origin of the disease is not precisely known, it is difficult to identify therapeutic targets and develop effective drugs. Although specific brain damage is observed in Alzheimer’s patients, research on the topic, particularly on amyloid plaques, has resulted in many failures over the years. However, a study presented at the end of July 2018 at the World Congress on Alzheimer’s disease in Chicago [3] raised hopes by revealing very encouraging results for a drug targeting the amyloid protein. The 854 patients included in the Phase II trial conducted by Biogen and Eisai Laboratories not only showed a significant decrease in brain damage, but also in cognitive decline. In addition, other paths are being investigated, although much less promising in the short term, such as a potential infectious origin of the disease; a study published at the end of June [4] revealed the frequent presence of the herpes virus in Alzheimer’s patients, while demonstrating that the infection is not facilitated by the disease. Herpes would thus be a cause rather than a consequence. What impact will these discoveries have on the new modalities of care? With more than 1,000 clinical trials conducted since the early 2000s on this condition, patience is still essential….
[1] https://www.inserm.fr/information-en-sante/dossiers-information/alzheimer-maladie
[2] https://www.fondation-mederic-alzheimer.org/sites/default/files/lettre_fma_4950_web_100718.pdf
[3] http://investors.biogen.com/news-releases/news-release-details/eisai-and-biogen-announce-detailed-results-phase-ii-clinical
[4] https://www.sciencedirect.com/science/article/pii/S0896627318304215?via%3Dihub