Research presented at the recent Alzheimer’s Association International Conference in Toronto offers hope that a new drug could halt the progression of the disease, the trials suggesting that the treatment – trontinemab – could be the most powerful weapon yet against dementia.
The Telegraph reports that further research will now examine whether the drug (from Roche) should be given to those without any symptoms to prevent the disease.
The results presented at the Canadian conference showed that the treatment can clear the devastating plaques associated with Alzheimer’s far faster than any current licensed treatment.
Nine in 10 patients prescribed trontinemab experienced amyloid clearance within 28 weeks, meaning visible markers of disease had vanished.
Experts hope these changes will be matched by improvements in memory and functioning, with an 18-month trial of 1 600 patients now under way.
Separate research will examine whether the drug could be given to people without any signs of dementia, in the same way that statins are used to ward off heart disease.
Experts said the findings were “very promising”, suggesting that the drug was much more powerful than existing medications, with far fewer side effects.
Powerful precise effects at low doses
Trontinemab is one of a class of new medicines aimed at clearing amyloid plaques. The new findings from phase two trials suggest that, in less than seven months, it has outperformed the ability of existing drugs to clear plaques in 18 months.
Experts hope that if given early enough, the medication could save some patients from developing symptoms at all. It has been engineered to more easily cross the blood-brain barrier, meaning it can ensure powerful precise effects at low doses.
The lack of side effects means it could be offered to large populations – and at a far lower price than current medications, which require intense monitoring, including regular scans.
Health professions suggest it could become the first Alzheimer’s drug to be funded by Britain’s NHS.
Last year, medicines regulators in the UK gave the green light to the first two treatments found to slow progression of Alzheimer’s disease.
Both lecanemab and donanemab use monoclonal antibodies to clear amyloid plaques in Alzheimer’s disease. In trials they have been found to slow decline by 27% and 35% respectively, over 18 months. However, the risk of brain swelling and brain bleeds means they need intense monitoring.
The new drug appears to have a far better safety profile. The phase two trial of 149 patients found less than 5% of cases suffering amyloid-related imaging abnormalities, and all cases quickly resolved.
It also requires less frequent infusions, with mass trials to examine the impact of giving the drug to patients once a month for six months, then every three months.
Scientists have been intrigued by the promise of trontinemab because of how it has been designed to be transported across the blood brain-barrier, which normally prevents chemicals in the bloodstream from entering the brain.
Professor Sir John Hardy, hairman of molecular biology of neurological disease at University College London’s Institute of Neurology, said the advance was great news.
“It sucks the plaque out of the brain really quickly, much faster than we have seen with lecanemab or donanemab.”
The scientist, who was the first to identify the role of amyloid in the disease, said the drug’s safety profile was a “massive improvement” on the current drugs on the market, raising hopes it could be used both to prevent disease and stop it in its tracks.
He said: “We hope that if we can use these drugs to people early, we can halt the progression of disease, even before people have symptoms. Now we need to see the size of the clinical effect.”
Neither of the current drugs has been funded by the NHS as a result of their high costs, much of which stems from the need for intense monitoring, including regular scans.
‘Very promising evidence’
Prof Jonathan Schott, chief medical officer at Alzheimer’s Research UK, said: “We urgently need a range of treatments for Alzheimer’s that are effective and safe for the people affected by this devastating disease.
“Evidence presented … on trontinemab is very promising, showing the drug can effectively and rapidly clear amyloid from the brain, seemingly with very few side effects.
“We now need to see whether these early stage results carry through to later stage clinical trials, which are planned to start later this year. These ill show whether the drug is not only safe, but has an impact on memory, thinking and quality of life.”
He said it was “exciting” that the drug would now be tested in some people without symptoms under the phase three trials.
The Telegraph article – New drug could halt Alzheimer’s (Restricted access)
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Promising results for new Alzheimer’s drug