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Bader I, Bader I, Lopes Alves I, Vállez García D, Vellas B, Dubois B, Boada M, Marquié M, Altomare D, Scheltens P, Vandenberghe R, Hanseeuw B, Schöll M, Frisoni GB, Jessen F, Nordberg A, Kivipelto M, Ritchie CW, Grau-Rivera O, Molinuevo JL, Ford L, Stephens A, Gismondi R, Gispert JD, Farrar G, Barkhof F, Visser PJ, Collij LE. Recruitment of pre-dementia participants: main enrollment barriers in a longitudinal amyloid-PET study. Alzheimers Res Ther 2023; 15:189. [PMID: 37919783 PMCID: PMC10621165 DOI: 10.1186/s13195-023-01332-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/13/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND The mismatch between the limited availability versus the high demand of participants who are in the pre-dementia phase of Alzheimer's disease (AD) is a bottleneck for clinical studies in AD. Nevertheless, potential enrollment barriers in the pre-dementia population are relatively under-reported. In a large European longitudinal biomarker study (the AMYPAD-PNHS), we investigated main enrollment barriers in individuals with no or mild symptoms recruited from research and clinical parent cohorts (PCs) of ongoing observational studies. METHODS Logistic regression was used to predict study refusal based on sex, age, education, global cognition (MMSE), family history of dementia, and number of prior study visits. Study refusal rates and categorized enrollment barriers were compared between PCs using chi-squared tests. RESULTS 535/1856 (28.8%) of the participants recruited from ongoing studies declined participation in the AMYPAD-PNHS. Only for participants recruited from clinical PCs (n = 243), a higher MMSE-score (β = - 0.22, OR = 0.80, p < .05), more prior study visits (β = - 0.93, OR = 0.40, p < .001), and positive family history of dementia (β = 2.08, OR = 8.02, p < .01) resulted in lower odds on study refusal. General study burden was the main enrollment barrier (36.1%), followed by amyloid-PET related burden (PCresearch = 27.4%, PCclinical = 9.0%, X2 = 10.56, p = .001), and loss of research interest (PCclinical = 46.3%, PCresearch = 16.5%, X2 = 32.34, p < .001). CONCLUSIONS The enrollment rate for the AMYPAD-PNHS was relatively high, suggesting an advantage of recruitment via ongoing studies. In this observational cohort, study burden reduction and tailored strategies may potentially improve participant enrollment into trial readiness cohorts such as for phase-3 early anti-amyloid intervention trials. The AMYPAD-PNHS (EudraCT: 2018-002277-22) was approved by the ethical review board of the VU Medical Center (VUmc) as the Sponsor site and in every affiliated site.
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Affiliation(s)
- Ilse Bader
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.
- Amsterdam Neuroscience, Neurodegeneration, 1081 HV, Amsterdam, The Netherlands.
| | - Ilona Bader
- Radiology & Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, 1081 HV, The Netherlands
| | - Isadora Lopes Alves
- Radiology & Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, 1081 HV, The Netherlands
- Brain Research Center, 1081 GN, Amsterdam, The Netherlands
| | - David Vállez García
- Radiology & Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, 1081 HV, The Netherlands
| | - Bruno Vellas
- Gérontopole of Toulouse, University Hospital of Toulouse (CHU-Toulouse), 31300, Toulouse, France
- UMR INSERM 1027, University of Toulouse III, 31062, Toulouse, France
| | - Bruno Dubois
- Institute of Memory and Alzheimer's Disease (IM2A) and Brain Institute, Salpetriere Hospital, Sorbonne University, 75013, Paris, France
| | - Mercè Boada
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08028, Barcelona, Spain
- Networking Research Center On Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Marta Marquié
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya (UIC), 08028, Barcelona, Spain
- Networking Research Center On Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Daniele Altomare
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, 25123, Brescia, Italy
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, 1081 HV, Amsterdam, The Netherlands
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Leuven Brain Institute, KU Leuven, 3001, Louvain, Belgium
| | - Bernard Hanseeuw
- Institute of Neuroscience, Université Catholique de Louvain, 1200, Brussels, Belgium
- Department of Neurology, Clinique Universitaires Saint-Luc, 1200, Brussels, Belgium
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, 02155, USA
- WELBIO Department, WEL Research Institute, Avenue Pasteur, 6, 1300, Wavre, Belgium
| | - Michael Schöll
- Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, 405 30, Gothenburg, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, 405 30, Gothenburg, Sweden
- Dementia Research Centre, Queen Institute of Neurology, University College London, London, WC1N 3BG, UK
| | - Giovanni B Frisoni
- Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva, 1205, Geneva, Switzerland
- Geneva Memory Center, Geneva University Hospitals, 1205, Geneva, Switzerland
| | - Frank Jessen
- German Center for Neurodegenerative Diseases (DZNE), 53127, Bonn, Germany
| | - Agneta Nordberg
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, 171 77, Stockholm, Sweden
- Theme Inflammation, Karolinska University Hospital, Stockholm, 171 77, Sweden
- Theme Aging, Karolinska University Hospital, Stockholm, 171 77, Sweden
| | - Miia Kivipelto
- Kuopio University Hospital, 70210, Kuopio, Finland
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences, and Society (NVS), Karolinska Institutet, 171 77, Stockholm, Sweden
- Imperial College London, London, SW7 2AZ, UK
| | | | - Oriol Grau-Rivera
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, 08005, Barcelona, Spain
| | - José Luis Molinuevo
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, 08005, Barcelona, Spain
- H. Lundbeck A/S, 2500, Copenhagen, Denmark
| | - Lisa Ford
- Janssen Research and Development, Titusville, NJ, 08560, USA
| | | | | | - Juan Domingo Gispert
- Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, 08005, Barcelona, Spain
| | - Gill Farrar
- GE Healthcare, Pharmaceutical Diagnostics, Amersham, HP7 9LL, UK
| | - Frederik Barkhof
- Radiology & Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, 1081 HV, The Netherlands
- Institutes of Neurology and Healthcare Engineering, UCL, London, WC1N 3BG, UK
| | - Pieter Jelle Visser
- Alzheimer Center Amsterdam, Neurology, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, 1081 HV, Amsterdam, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht University, Maastricht, 6229 ER, The Netherlands
| | - Lyduine E Collij
- Radiology & Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC Location VUmc, 1081 HZ, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Brain Imaging, Amsterdam, 1081 HV, The Netherlands
- Clinical Memory Research Unit, Department of Clinical Sciences, Lund University, 221 00, Malmö, Sweden
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Leroy V, Gana W, Aïdoud A, N'kodo JA, Balageas AC, Blanc P, Bomia D, Debacq C, Fougère B. Digital health technologies and Alzheimer's disease clinical trials: might decentralized clinical trials increase participation by people with cognitive impairment? Alzheimers Res Ther 2023; 15:87. [PMID: 37106429 PMCID: PMC10133908 DOI: 10.1186/s13195-023-01227-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Therapeutic trials in Alzheimer's disease (AD) face many obstacles-particularly with regard to screening and recruitment. DISCUSSION Decentralized clinical trials (DCTs) are being developed in other diseases and appear to be of value for overcoming these difficulties. The use of remote visits offers hope of broader recruitment and thus a reduction in inequalities due to age, geography, and ethnicity. Furthermore, it might be easier to involve primary care providers and caregivers in DCTs. However, further studies are needed to determine the feasibility of DCTs in AD. A mixed-model DCT might constitute the first step towards completely remote trials in AD and should be assessed first.
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Affiliation(s)
- Victoire Leroy
- Department of Geriatrics, Tours University Hospital, Tours, France.
- Memory Clinic, Tours University Hospital, Tours, France.
| | - Wassim Gana
- Department of Geriatrics, Tours University Hospital, Tours, France
| | - Amal Aïdoud
- Department of Geriatrics, Tours University Hospital, Tours, France
- EA4245 T2i, Université de Tours, Tours, France
| | | | | | - Pascal Blanc
- Department of Geriatrics, Tours University Hospital, Tours, France
- Memory Clinic, Tours University Hospital, Tours, France
| | | | - Camille Debacq
- Department of Geriatrics, Tours University Hospital, Tours, France
| | - Bertrand Fougère
- Department of Geriatrics, Tours University Hospital, Tours, France
- EA 7505 Education, Ethics, Health, Tours University, Tours, France
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Shimada H, Makino K, Kato T, Ito K. Computer-based cognitive tests and cerebral pathology among Japanese older adults. BMC Geriatr 2023; 23:226. [PMID: 37038102 PMCID: PMC10084669 DOI: 10.1186/s12877-023-03918-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/22/2023] [Indexed: 04/12/2023] Open
Abstract
BACKGROUND This study aimed to identify the appropriate computer-based cognitive tests and cut-off values for estimating amyloid burden in preclinical Alzheimer's disease drug trials. METHODS Data from 103 older individuals, who underwent 18F-florbetapir positron emission tomography and cognitive testing, were analyzed. Cognitive tests evaluated word list memory (immediate recognition and delayed recall), attention (Trail Making Test-part A), executive function (Trail Making Test-Part B), and processing speed (Digit Symbol Substitution Test [DSST]). RESULTS The Aβ burden was significantly associated with word list memory (odds ratio [OR] = 0.42, 95% confidence interval [CI], 0.19-0.91) and DSST (OR = 0.35; 95% CI, 0.14-0.85). Positive predictive value and number needed to screen at a cut-off of 1.5 SD were better for word list memory and DSST among predictive values. CONCLUSIONS The computer-based memory and processing speed tests have the potential to reduce failure rates while screening individuals with Aβ accumulation in community settings.
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Affiliation(s)
- Hiroyuki Shimada
- Department of Preventive Gerontology, Centre for Gerontology and Social Science, National Centre for Geriatrics and Gerontology, Aichi, Japan.
| | - Keitaro Makino
- Department of Preventive Gerontology, Centre for Gerontology and Social Science, National Centre for Geriatrics and Gerontology, Aichi, Japan
| | - Takashi Kato
- Department of Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Kengo Ito
- Department of Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology, Aichi, Japan
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Howell T, Gummadi S, Bui C, Santhakumar J, Knight K, Roberson ED, Marson D, Chambless C, Gersteneker A, Martin R, Kennedy R, Zhang Y, Morris JC, Moulder KL, Mayo C, Carroll M, Li Y, Petersen RC, Stricker NH, Nosheny RL, Mackin S, Weiner MW. Development and implementation of an electronic Clinical Dementia Rating and Financial Capacity Instrument-Short Form. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2022; 14:e12331. [PMID: 35898521 PMCID: PMC9309008 DOI: 10.1002/dad2.12331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
Introduction To address the need for remote assessments of cognitive decline and dementia, we developed and administered electronic versions of the Clinical Dementia Rating (CDR®) and the Financial Capacity Instrument-Short Form (FCI-SF) (F-CAP®), called the eCDR and eFCI, respectively. Methods The CDR and FCI-SF were adapted for remote, unsupervised, online use based on item response analysis of the standard instruments. Participants completed the eCDR and eFCI first in clinic, and then at home within 2 weeks. Results Of the 243 enrolled participants, 179 (73%) cognitively unimpaired (CU), 50 (21%) with mild cognitive impairment (MCI) or dementia, and 14 (6%) with an unknown diagnosis, 84% and 85% of them successfully completed the eCDR and eFCI, respectively, at home. Discussion These results show initial feasibility in developing and administering online instruments to remotely assess and monitor cognitive decline along the CU to MCI/very mild dementia continuum. Validation is an important next step.
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Affiliation(s)
- Taylor Howell
- San Francisco Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
| | - Shilpa Gummadi
- San Francisco Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
| | - Chau Bui
- San Francisco Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
| | - Jessica Santhakumar
- San Francisco Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
| | - Kristen Knight
- San Francisco Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
| | - Erik D. Roberson
- Alzheimer's Disease CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Daniel Marson
- Alzheimer's Disease CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Carol Chambless
- Alzheimer's Disease CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Adam Gersteneker
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Roy Martin
- Department of NeurologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Richard Kennedy
- Alzheimer's Disease CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Division of Gerontology, Geriatrics, and Palliative CareDepartment of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Yue Zhang
- Division of Gerontology, Geriatrics, and Palliative CareDepartment of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - John C. Morris
- Department of NeurologyWashington University in St. LouisSt. LouisMissouriUSA
| | - Krista L. Moulder
- Department of NeurologyWashington University in St. LouisSt. LouisMissouriUSA
| | - Connie Mayo
- Department of NeurologyWashington University in St. LouisSt. LouisMissouriUSA
| | - Maria Carroll
- Department of NeurologyWashington University in St. LouisSt. LouisMissouriUSA
| | - Yan Li
- Department of NeurologyWashington University in St. LouisSt. LouisMissouriUSA
| | | | - Nikki H. Stricker
- Mayo ClinicDepartment of Psychiatry and PsychologyRochesterMinnesotaUSA
| | - Rachel L. Nosheny
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
- San Francisco Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Scott Mackin
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
- San Francisco Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Michael W. Weiner
- San Francisco Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
- VA Advanced Imaging Research CenterSan Francisco Veteran's Administration Medical CenterSan FranciscoCaliforniaUSA
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Howell T, Neuhaus J, Glymour MM, Weiner MW, Nosheny RL. Validity of Online Versus In-Clinic Self-Reported Everyday Cognition Scale. J Prev Alzheimers Dis 2022; 9:269-276. [PMID: 35543000 PMCID: PMC9881822 DOI: 10.14283/jpad.2022.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Online cognitive assessments are alternatives to in-clinic assessments. OBJECTIVES We evaluated the relationship between online and in-clinic self-reported Everyday Cognition Scale (ECog). METHODS In 94 Alzheimer's Disease Neuroimaging Initiative and Brain Health Registry (ADNI-BHR) participants, we estimated associations between online and in-clinic Everyday Cognition using Bland-Altman plots and regression. In 472 ADNI participants, we estimated reliability of in-clinic Everyday Cognition completed six months apart using Bland-Altman plots and regression. RESULTS Online Everyday Cognition associations: Mean difference was 0.11 (95% limits of agreement: -0.41 to 0.64). In-clinic Everyday Cognition score increased by 0.81 for each online Everyday Cognition score unit increase (R2=0.60). In-clinic Everyday Cognition reliability: Mean difference was 0.01 (95% limits of agreement: -0.61 to 0.62). In-clinic Everyday Cognition score at enrollment increased by 0.79 for each in-clinic Everyday Cognition score unit increase at six months (R2=0.61). CONCLUSION Online Everyday Cognition closely corresponded with in-clinic Everyday Cognition, supporting validity of using online cognitive assessments to more efficiently facilitate Alzheimer's disease research.
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Affiliation(s)
- Taylor Howell
- University of California San Francisco Department of Epidemiology & Biostatistics, San Francisco, CA, 94158, USA,San Francisco Veteran’s Administration Medical Center, San Francisco, CA, 94121, USA,University of California San Francisco Department of Radiology and Biomedical Imaging, San Francisco, CA, 94143, USA,Corresponding author: Taylor Howell, , Mailing Address: 4150 Clement Street, Mail Stop: #114M Building 13 San Francisco, California 94121, Telephone: 415-221-4810 x24222
| | - John Neuhaus
- University of California San Francisco Department of Epidemiology & Biostatistics, San Francisco, CA, 94158, USA
| | - M. Maria Glymour
- University of California San Francisco Department of Epidemiology & Biostatistics, San Francisco, CA, 94158, USA
| | - Michael W Weiner
- San Francisco Veteran’s Administration Medical Center, San Francisco, CA, 94121, USA,University of California San Francisco Department of Radiology and Biomedical Imaging, San Francisco, CA, 94143, USA
| | - Rachel L Nosheny
- San Francisco Veteran’s Administration Medical Center, San Francisco, CA, 94121, USA,University of California San Francisco Department of Psychiatry, San Francisco, CA, 94143, USA
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Serum Corticosterone and Insulin Resistance as Early Biomarkers in the hAPP23 Overexpressing Mouse Model of Alzheimer's Disease. Int J Mol Sci 2021; 22:ijms22136656. [PMID: 34206322 PMCID: PMC8269119 DOI: 10.3390/ijms22136656] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 12/21/2022] Open
Abstract
Increasing epidemiological evidence highlights the association between systemic insulin resistance and Alzheimer’s disease (AD). As insulin resistance can be caused by high-stress hormone levels and since hypercortisolism appears to be an important risk factor of AD, we aimed to investigate the systemic insulin functionality and circulating stress hormone levels in a mutant humanized amyloid precursor protein (APP) overexpressing (hAPP23+/−) AD mouse model. Memory and spatial learning of male hAPP23+/− and C57BL/6 (wild type, WT) mice were assessed by a Morris Water Maze (MWM) test at the age of 4 and 12 months. The systemic metabolism was examined by intraperitoneal glucose and insulin tolerance tests (GTT, ITT). Insulin and corticosterone levels were determined in serum. In the hippocampus, parietal and occipital cortex of hAPP23+/− brains, amyloid-beta (Aβ) deposits were present at 12 months of age. MWM demonstrated a cognitive decline in hAPP23+/− mice at 12 but not at 4 months, evidenced by increasing total path lengths and deteriorating probe trials compared to WT mice. hAPP23+/− animals presented increased serum corticosterone levels compared to WT mice at both 4 and 12 months. hAPP23+/− mice exhibited peripheral insulin resistance compared to WT mice at 4 months, which stabilized at 12 months of age. Serum insulin levels were similar between genotypes at 4 months of age but were significantly higher in hAPP23+/− mice at 12 months of age. Peripheral glucose homeostasis remained unchanged. These results indicate that peripheral insulin resistance combined with elevated circulating stress hormone levels could be potential biomarkers of the pre-symptomatic phase of AD.
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Jiang Z, Wang X, Xia J. Considerations on the clinical development of COVID-19 vaccine from trial design perspectives. Hum Vaccin Immunother 2021; 17:656-660. [PMID: 32991223 PMCID: PMC7993126 DOI: 10.1080/21645515.2020.1815489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
COVID-19 has become a global pandemic, and an effective vaccine is needed. During the outbreak, the urgency for developing candidate vaccines has brought distinct challenges to clinical development. An efficacy trial, which measures whether the vaccine reduces the incidence of disease, is ordinarily required to fully evaluate vaccine efficacy. However, emergency use may be possible if promising immunogenicity results are observed. A ring vaccination trial, which recruits subjects connected to a known case either socially or geographically, is a solution to evaluate vaccine efficacy and control the spread of the disease simultaneously although its conduct is challenging. Nevertheless, when COVID-19 becomes a recurrent epidemic, an 'individual-level' efficacy trial is preferred. Innovative statistical designs, including seamless design, platform trial, master protocol design, are helpful to accelerate clinical development. A seamless Phase I/II design has been applied in multiple COVID-19 vaccine studies to date. However, Phase II/III design should be done very carefully. The control of type I error, maintaining trial blinding and statistical methods leading to unbiased estimates should be pre-specified in the clinical protocol. A Data Safety Monitoring Board is especially important, given the need to assure an adequate level of safety when society want a safe and effective vaccine.
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Affiliation(s)
- Zhiwei Jiang
- Department of Biostatistics, Beijing KeyTech Statistical Consulting Co., Ltd, Beijing, China
| | - Xuanyi Wang
- Key Laboratory Medical Molecular Virology, MoE/MoH, and the Institutes of Biomedical Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jielai Xia
- Department of Health Statistics, Air Force Military Medical University, Xi'an, Shaanxi Province, China
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Dietzel N, Kürten L, Karrer L, Reichold M, Köhler L, Nagel A, Chmelirsch C, Seebahn K, Hladik M, Meuer S, Kirchner A, Holm K, Selau M, Wendel M, Trinkwalter J, Prokosch HU, Graessel E, Kolominsky-Rabas PL. Digital Dementia Registry Bavaria-digiDEM Bayern: study protocol for a multicentre, prospective, longitudinal register study. BMJ Open 2021; 11:e043473. [PMID: 33558357 PMCID: PMC7871684 DOI: 10.1136/bmjopen-2020-043473] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Dementia is one of the most relevant widespread diseases, with a prevalence of currently 50 million people with dementia worldwide. The care of people with dementia will be one of the major challenges for healthcare systems worldwide. Digitalisation offers new possibilities to improve both dementia healthcare and health outcomes research as a fundament for national healthcare planning. The 'Digital Dementia Registry Bavaria-digiDEM Bayern' aims to improve the understanding of the complexity and long-term progression of dementia and the current care situation in Bavaria. Moreover, by offering digital services, digiDEM will actively contribute to improving the care situation in Bavaria. METHODS AND ANALYSIS: digiDEM will recruit people with dementia and their family caregivers in all administrative regions of Bavaria. All participants will undergo dementia screening prior to study inclusion in order to identify people with mild cognitive impairment and mild-to-moderate dementia. Participants will be followed up over a period of three years. Sociodemographic data, type of dementia, symptoms, diagnosis, cognitive trajectories, activities of daily living, behavioural and psychological symptoms, falls, resource utilisation, caregiver burden, quality of life, needs of people with dementia and their caregivers, mobility, use of media and sources of information will be assessed. The project will implement a digital web-based platform for data collection. Data will be collected by means of standardised online or face-to-face interviews. ETHICS AND DISSEMINATION The study obtained ethical approval from the Ethics Committee of the Medical Faculty of Friedrich-Alexander-University Erlangen-Nürnberg (FAU) (application number: 253_20 B). Findings will be used for evidence-based decision-making for health decision-makers in order to optimise dementia healthcare in the state of Bavaria. Specific analyses will be conducted for the participating research partners. Results of the study will be published in peer-reviewed journals.
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Affiliation(s)
- Nikolas Dietzel
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Lara Kürten
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Linda Karrer
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Michael Reichold
- Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Laura Köhler
- Medical Valley European Metropolitan Region Nuremberg Association, Erlangen, Germany
| | - Andreas Nagel
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Christina Chmelirsch
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Kathrin Seebahn
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Markus Hladik
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Sebastian Meuer
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Anna Kirchner
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Kristina Holm
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Marina Selau
- Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Marco Wendel
- Medical Valley European Metropolitan Region Nuremberg Association, Erlangen, Germany
| | - Jörg Trinkwalter
- Medical Valley European Metropolitan Region Nuremberg Association, Erlangen, Germany
| | - Hans-Ulrich Prokosch
- Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Elmar Graessel
- Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Peter L Kolominsky-Rabas
- Interdisciplinary Center for Health Technology Assessment and Public Health (IZPH), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Vidoni ED, Szabo-Reed A, Kang C, Shaw AR, Perales-Puchalt J, Grove G, Hamill M, Henry D, Burns JM, Hillman C, Kramer AF, McAuley E, Erickson KI. The IGNITE trial: Participant recruitment lessons prior to SARS-CoV-2. Contemp Clin Trials Commun 2020; 20:100666. [PMID: 33052319 PMCID: PMC7544598 DOI: 10.1016/j.conctc.2020.100666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/20/2020] [Accepted: 10/03/2020] [Indexed: 12/19/2022] Open
Abstract
Full and diverse participant enrollment is critical to the success and generalizability of all large-scale Phase III trials. Recruitment of sufficient participants is among the most significant challenges for many studies. The novel SARS-CoV-2 coronavirus pandemic has further changed and challenged the landscape for clinical trial execution, including screening and randomization. The Investigating Gains in Neurocognition in an Intervention Trial of Exercise (IGNITE) study has been designed as the most comprehensive test of aerobic exercise effects on cognition and brain health. Here we assess recruitment into IGNITE prior to the increased infection rates in the United States, and examine new challenges and opportunities for recruitment with a goal of informing the remaining required recruitment as infection containment procedures are lifted. The results may assist the design and implementation of recruitment for future exercise studies, and outline opportunities for study design that are flexible in the face of emerging threats.
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Affiliation(s)
- Eric D. Vidoni
- University of Kansas Alzheimer's Disease Center, Fairway, KS, USA
| | | | | | - Ashley R. Shaw
- University of Kansas Alzheimer's Disease Center, Fairway, KS, USA
| | | | | | | | | | - Jeffrey M. Burns
- University of Kansas Alzheimer's Disease Center, Fairway, KS, USA
| | | | - Arthur F. Kramer
- Northeastern University, Boston, MA, USA
- Beckman Institute, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Edward McAuley
- University of Illinois Urbana-Champaign, Urbana, IL, USA
- Beckman Institute, University of Illinois Urbana-Champaign, Urbana, IL, USA
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10
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Olson NL, Albensi BC. Race- and Sex-Based Disparities in Alzheimer's Disease Clinical Trial Enrollment in the United States and Canada: An Indigenous Perspective. J Alzheimers Dis Rep 2020; 4:325-344. [PMID: 33024940 PMCID: PMC7504979 DOI: 10.3233/adr-200214] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Randomized clinical trials (RCT) involve labor-intensive, highly regulated, and controlled processes intended to transform scientific concepts into clinical outcomes. To be effective and targeted, it is imperative they include those populations who would most benefit from those outcomes. Alzheimer's disease (AD) is most detrimental to the aging population, and its clinical manifestation is influenced by socio-economic factors such as poverty, poor education, stress, and chronic co-morbidities. Indigenous populations in the United States and Canada are among the minority populations most influenced by poor socio-economic conditions and are prone to the ravages of AD, with Indigenous women carrying the added burden of exposure to violence, caregiving stresses, and increased risk by virtue of their sex. Race- and sex-based disparities in RCT enrollment has occurred for decades, with Indigenous men and women very poorly represented. In this review, we examined literature from the last twenty years that reinforce these disparities and provide some concrete suggestions and guidelines to increase the enrollment numbers in AD RCT among this vulnerable and poorly represented population.
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Affiliation(s)
- Nancy L Olson
- Division of Neurodegenerative Disorders, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada
| | - Benedict C Albensi
- Division of Neurodegenerative Disorders, St Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB, Canada
- Department of Pharmacology & Therapeutics, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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11
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The preclinical amyloid sensitive composite to determine subtle cognitive differences in preclinical Alzheimer's disease. Sci Rep 2020; 10:13583. [PMID: 32788669 PMCID: PMC7423599 DOI: 10.1038/s41598-020-70386-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022] Open
Abstract
Recently, the focus of Alzheimer's disease (AD) research has shifted from the clinical stage to the preclinical stage. We, therefore, aimed to develop a cognitive composite score that can detect the subtle cognitive differences between the amyloid positive (Aβ+) and negative (Aβ-) status in cognitively normal (CN) participants. A total of 423 CN participants with Aβ positron emission tomography images were recruited. The multiple-indicators multiple-causes model found the latent mean difference between the Aβ+ and Aβ- groups in the domains of verbal memory, visual memory, and executive functions. The multivariate analysis of covariance (MANCOVA) showed that the Aβ+ group performed worse in tests related to the verbal and visual delayed recall, semantic verbal fluency, and inhibition of cognitive inference within the three cognitive domains. The Preclinical Amyloid Sensitive Composite (PASC) model we developed using the result of MANCOVA and the MMSE presented a good fit with the data. The accuracy of the PASC score when applied with age, sex, education, and APOE ε4 for distinguishing between Aβ+ and Aβ- was adequate (AUC = 0.764; 95% CI = 0.667-0.860) in the external validation set (N = 179). We conclude that the PASC can eventually contribute to facilitating more prevention trials in preclinical AD.
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12
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Laverty H, Meulien P. The Innovative Medicines Initiative -10 Years of Public-Private Collaboration. Front Med (Lausanne) 2019; 6:275. [PMID: 31850354 PMCID: PMC6902875 DOI: 10.3389/fmed.2019.00275] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 11/11/2019] [Indexed: 12/30/2022] Open
Abstract
The Innovative Medicines Initiative (IMI) is a public-private partnership between the European Union and the European pharmaceutical industry. Born of the necessity to foster collaboration between different stakeholders in order to address growing challenges in bringing new medicines to market and the rapidly evolving healthcare landscape, IMI has successfully delivered the radical collaboration needed to address these challenges. In this article we reflect on some of the major achievements of the programme by highlighting a few of the key projects funded and the progress they have made, as well as some of the lessons learnt in delivering such an ambitious partnership. Those that drove the foundation of IMI recognized that to address these challenges required not just ambitious scientific approaches, but also an awareness of societal needs. Therefore, actors from beyond the traditional pharmaceutical research communities would be needed. One of the key successes of IMI has been to foster radical collaboration between diverse public and private partners of all types, including large pharmaceutical companies, SMEs, regulators, patient organizations and public research institutions. It has achieved this by being a neutral platform where all partners are bound by the same rights and responsibilities. Since it began there has been an evolution in the understanding of what is considered “pre-competitive,” resulting in IMI projects now addressing all of the steps within the pharmaceutical development value chain. With this expansion in the types of projects supported by IMI, different actors from beyond the traditional pharmaceutical research family have been attracted to participate, enriching further the collaboration at the heart of the programme. Finally, such a complex programme brings with it challenges, and we reflect on some of the important learnings that should be applied to future collaborative models to ensure that they are as successful as possible and deliver the expected impact.
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Affiliation(s)
- Hugh Laverty
- Head of Scientific Operations, Innovative Medicines Initiative, Brussels, Belgium
| | - Pierre Meulien
- Executive Director, Innovative Medicines Initiative, Brussels, Belgium
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13
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Cummings J, Feldman HH, Scheltens P. The "rights" of precision drug development for Alzheimer's disease. Alzheimers Res Ther 2019; 11:76. [PMID: 31470905 PMCID: PMC6717388 DOI: 10.1186/s13195-019-0529-5] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/13/2019] [Indexed: 01/12/2023]
Abstract
There is a high rate of failure in Alzheimer's disease (AD) drug development with 99% of trials showing no drug-placebo difference. This low rate of success delays new treatments for patients and discourages investment in AD drug development. Studies across drug development programs in multiple disorders have identified important strategies for decreasing the risk and increasing the likelihood of success in drug development programs. These experiences provide guidance for the optimization of AD drug development. The "rights" of AD drug development include the right target, right drug, right biomarker, right participant, and right trial. The right target identifies the appropriate biologic process for an AD therapeutic intervention. The right drug must have well-understood pharmacokinetic and pharmacodynamic features, ability to penetrate the blood-brain barrier, efficacy demonstrated in animals, maximum tolerated dose established in phase I, and acceptable toxicity. The right biomarkers include participant selection biomarkers, target engagement biomarkers, biomarkers supportive of disease modification, and biomarkers for side effect monitoring. The right participant hinges on the identification of the phase of AD (preclinical, prodromal, dementia). Severity of disease and drug mechanism both have a role in defining the right participant. The right trial is a well-conducted trial with appropriate clinical and biomarker outcomes collected over an appropriate period of time, powered to detect a clinically meaningful drug-placebo difference, and anticipating variability introduced by globalization. We lack understanding of some critical aspects of disease biology and drug action that may affect the success of development programs even when the "rights" are adhered to. Attention to disciplined drug development will increase the likelihood of success, decrease the risks associated with AD drug development, enhance the ability to attract investment, and make it more likely that new therapies will become available to those with or vulnerable to the emergence of AD.
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Affiliation(s)
- Jeffrey Cummings
- Department of Brain Health, School of Integrated Health Sciences, UNLV and Cleveland Clinic Lou Ruvo Center for Brain Health, 888 West Bonneville Ave, Las Vegas, NV, 89106, USA.
| | - Howard H Feldman
- Department of Neurosciences, Alzheimer's Disease Cooperative Study, University of California San Diego, San Diego, CA, USA
| | - Philip Scheltens
- Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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14
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Nakamura A, Cuesta P, Fernández A, Arahata Y, Iwata K, Kuratsubo I, Bundo M, Hattori H, Sakurai T, Fukuda K, Washimi Y, Endo H, Takeda A, Diers K, Bajo R, Maestú F, Ito K, Kato T. Electromagnetic signatures of the preclinical and prodromal stages of Alzheimer's disease. Brain 2019. [PMID: 29522156 PMCID: PMC5920328 DOI: 10.1093/brain/awy044] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Biomarkers useful for the predementia stages of Alzheimer’s disease are needed. Electroencephalography and magnetoencephalography (MEG) are expected to provide potential biomarker candidates for evaluating the predementia stages of Alzheimer’s disease. However, the physiological relevance of EEG/MEG signal changes and their role in pathophysiological processes such as amyloid-β deposition and neurodegeneration need to be elucidated. We evaluated 28 individuals with mild cognitive impairment and 38 cognitively normal individuals, all of whom were further classified into amyloid-β-positive mild cognitive impairment (n = 17, mean age 74.7 ± 5.4 years, nine males), amyloid-β-negative mild cognitive impairment (n = 11, mean age 73.8 ± 8.8 years, eight males), amyloid-β-positive cognitively normal (n = 13, mean age 71.8 ± 4.4 years, seven males), and amyloid-β-negative cognitively normal (n = 25, mean age 72.5 ± 3.4 years, 11 males) individuals using Pittsburgh compound B-PET. We measured resting state MEG for 5 min with the eyes closed, and investigated regional spectral patterns of MEG signals using atlas-based region of interest analysis. Then, the relevance of the regional spectral patterns and their associations with pathophysiological backgrounds were analysed by integrating information from Pittsburgh compound B-PET, fluorodeoxyglucose-PET, structural MRI, and cognitive tests. The results demonstrated that regional spectral patterns of resting state activity could be separated into several types of MEG signatures as follows: (i) the effects of amyloid-β deposition were expressed as the alpha band power augmentation in medial frontal areas; (ii) the delta band power increase in the same region was associated with disease progression within the Alzheimer’s disease continuum and was correlated with entorhinal atrophy and an Alzheimer’s disease-like regional decrease in glucose metabolism; and (iii) the global theta power augmentation, which was previously considered to be an Alzheimer’s disease-related EEG/MEG signature, was associated with general cognitive decline and hippocampal atrophy, but was not specific to Alzheimer’s disease because these changes could be observed in the absence of amyloid-β deposition. The results suggest that these MEG signatures may be useful as unique biomarkers for the predementia stages of Alzheimer’s disease.
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Affiliation(s)
- Akinori Nakamura
- Department of Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology, Obu, 474-8511, Japan
| | - Pablo Cuesta
- Department of Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology, Obu, 474-8511, Japan.,Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology, Complutense University of Madrid and Technical University of Madrid, Madrid, 28223, Spain.,Electrical Engineering and Bioengineering Lab, Department of Industrial Engineering, University of La Laguna, Tenerife, 38200, Spain
| | - Alberto Fernández
- Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology, Complutense University of Madrid and Technical University of Madrid, Madrid, 28223, Spain.,Department of Psychiatry, Faculty of Medicine, Complutense University of Madrid, Madrid, 28040, Spain
| | - Yutaka Arahata
- National Hospital for Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, 474-8511, Japan.,Innovation Center for Clinical Research, National Center for Geriatrics and Gerontology, Obu, 474-8511, Japan
| | - Kaori Iwata
- Department of Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology, Obu, 474-8511, Japan
| | - Izumi Kuratsubo
- Innovation Center for Clinical Research, National Center for Geriatrics and Gerontology, Obu, 474-8511, Japan
| | - Masahiko Bundo
- Department of Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology, Obu, 474-8511, Japan.,National Hospital for Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, 474-8511, Japan
| | - Hideyuki Hattori
- National Hospital for Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, 474-8511, Japan
| | - Takashi Sakurai
- National Hospital for Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, 474-8511, Japan
| | - Koji Fukuda
- National Hospital for Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, 474-8511, Japan
| | - Yukihiko Washimi
- National Hospital for Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, 474-8511, Japan
| | - Hidetoshi Endo
- National Hospital for Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, 474-8511, Japan
| | - Akinori Takeda
- National Hospital for Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, 474-8511, Japan
| | - Kersten Diers
- Department of Psychology, Technische Universität Dresden, Dresden, 01069, Germany
| | - Ricardo Bajo
- Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology, Complutense University of Madrid and Technical University of Madrid, Madrid, 28223, Spain
| | - Fernando Maestú
- Laboratory of Cognitive and Computational Neuroscience, Center for Biomedical Technology, Complutense University of Madrid and Technical University of Madrid, Madrid, 28223, Spain.,Department of Basic Psychology II, Complutense University of Madrid, Madrid, 28223, Spain
| | - Kengo Ito
- Department of Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology, Obu, 474-8511, Japan.,National Hospital for Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, 474-8511, Japan.,Innovation Center for Clinical Research, National Center for Geriatrics and Gerontology, Obu, 474-8511, Japan
| | - Takashi Kato
- Department of Clinical and Experimental Neuroimaging, National Center for Geriatrics and Gerontology, Obu, 474-8511, Japan.,National Hospital for Geriatric Medicine, National Center for Geriatrics and Gerontology, Obu, 474-8511, Japan
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15
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Cummings J, Ritter A, Zhong K. Clinical Trials for Disease-Modifying Therapies in Alzheimer's Disease: A Primer, Lessons Learned, and a Blueprint for the Future. J Alzheimers Dis 2019; 64:S3-S22. [PMID: 29562511 PMCID: PMC6004914 DOI: 10.3233/jad-179901] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Alzheimer’s disease (AD) has no currently approved disease-modifying therapies (DMTs), and treatments to prevent, delay the onset, or slow the progression are urgently needed. A delay of 5 years if available by 2025 would decrease the total number of patients with AD by 50% in 2050. To meet the definition of DMT, an agent must produce an enduring change in the course of AD; clinical trials of DMTs have the goal of demonstrating this effect. AD drug discovery entails target identification followed by high throughput screening and lead optimization of drug-like compounds. Once an optimized agent is available and has been assessed for efficacy and toxicity in animals, it progresses through Phase I testing with healthy volunteers, Phase II learning trials to establish proof-of-mechanism and dose, and Phase III confirmatory trials to demonstrate efficacy and safety in larger populations. Phase III is followed by Food and Drug Administration review and, if appropriate, market access. Trial populations include cognitively normal at-risk participants in prevention trials, mildly impaired participants with biomarker evidence of AD in prodromal AD trials, and subjects with cognitive and functional impairment in AD dementia trials. Biomarkers are critical in trials of DMTs, assisting in participant characterization and diagnosis, target engagement and proof-of-pharmacology, demonstration of disease-modification, and monitoring side effects. Clinical trial designs include randomized, parallel group; delayed start; staggered withdrawal; and adaptive. Lessons learned from completed trials inform future trials and increase the likelihood of success.
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Affiliation(s)
- Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Aaron Ritter
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Kate Zhong
- Global Alzheimer Platform, Washington, DC, USA
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16
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Langbaum JB, Karlawish J, Roberts JS, Wood EM, Bradbury A, High N, Walsh TL, Gordon D, Aggarwal R, Davis P, Stowell C, Trisko L, Langlois CM, Reiman EM, Tariot PN. GeneMatch: A novel recruitment registry using at-home APOE genotyping to enhance referrals to Alzheimer's prevention studies. Alzheimers Dement 2019; 15:515-524. [PMID: 30772251 PMCID: PMC6461487 DOI: 10.1016/j.jalz.2018.12.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/16/2018] [Accepted: 12/11/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Recruitment for Alzheimer's disease (AD) prevention research studies is challenging because of lack of awareness among cognitively healthy adults coupled with the high screen fail rate due to participants not having a genetic risk factor or biomarker evidence of the disease. Participant recruitment registries offer one solution for efficiently and effectively identifying, characterizing, and connecting potential eligible volunteers to studies. METHODS Individuals aged 55-75 years who live in the United States and self-report not having a diagnosis of cognitive impairment such as MCI or dementia are eligible to join GeneMatch. Participants enroll online and are provided a cheek swab kit for DNA extraction and apolipoprotein E (APOE) genotyping. Participants are not told their APOE results, although the results may be used in part to help match participants to AD prevention studies. RESULTS As of August 2018, 75,351 participants had joined GeneMatch. Nearly 30% of participants have one APOE4 allele, and approximately 3% have two APOE4 alleles. The percentages of APOE4 heterozygotes and homozygotes are inversely associated with age (P < .001). DISCUSSION GeneMatch, the first trial-independent research enrollment program designed to recruit and refer cognitively healthy adults to AD prevention studies based in part on APOE test results, provides a novel mechanism to accelerate prescreening and enrollment for AD prevention trials.
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Affiliation(s)
| | - Jason Karlawish
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - J Scott Roberts
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Elisabeth M Wood
- Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Angela Bradbury
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, USA; Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nellie High
- Banner Alzheimer's Institute, Phoenix, AZ, USA
| | | | | | | | | | | | | | | | - Eric M Reiman
- Banner Alzheimer's Institute, Phoenix, AZ, USA; Neurodegenerative Disease Research Center, Arizona State University, Tempe, AZ, USA; Department of Psychiatry, University of Arizona, Tucson, AZ, USA; Neurogenomics Division, Translational Genomics Research Institute, Phoenix, AZ, USA; Arizona Alzheimer's Consortium, Phoenix, AZ, USA
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17
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Arnold SE, Betensky RA. Multicrossover Randomized Controlled Trial Designs in Alzheimer Disease. Ann Neurol 2018; 84:168-175. [PMID: 30014506 DOI: 10.1002/ana.25280] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/28/2018] [Accepted: 06/24/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Steven E Arnold
- Interdisciplinary Brain Center for Clinical and Translational Research and Department of Neurology, Massachusetts General Hospital, Charlestown, MA
| | - Rebecca A Betensky
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA
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18
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Cummings J, Reiber C, Kumar P. The price of progress: Funding and financing Alzheimer's disease drug development. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2018; 4:330-343. [PMID: 30175227 PMCID: PMC6118094 DOI: 10.1016/j.trci.2018.04.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Advancing research and treatment for Alzheimer's disease (AD) and the search for effective treatments depend on a complex financial ecosystem involving federal, state, industry, advocacy, venture capital, and philanthropy funding approaches. METHODS We conducted an expert review of the literature pertaining to funding and financing of translational research and drug development for AD. RESULTS The federal government is the largest public funder of research in AD. The National Institute on Aging, National Institute of Mental Health, National Institute of General Medical Sciences, and National Center for Advancing Translational Science all fund aspects of research in AD drug development. Non-National Institutes of Health federal funding comes from the National Science Foundation, Veterans Administration, Food and Drug Administration, and the Center for Medicare and Medicaid Services. Academic Medical Centers host much of the federally funded basic science research and are increasingly involved in drug development. Funding of the "Valley of Death" involves philanthropy and federal funding through small business programs and private equity from seed capital, angel investors, and venture capital companies. Advocacy groups fund both basic science and clinical trials. The Alzheimer Association is the advocacy organization with the largest research support portfolio relevant to AD drug development. Pharmaceutical companies are the largest supporters of biomedical research worldwide; companies are most interested in late stage de-risked drugs. Drugs progressing into phase II and III are candidates for pharmaceutical industry support through licensing, mergers and acquisitions, and co-development collaborations. DISCUSSION Together, the funding and financing entities involved in supporting AD drug development comprise a complex, interactive, dynamic financial ecosystem. Funding source interaction is largely unstructured and available funding is insufficient to meet all demands for new therapies. Novel approaches to funding such as mega-funds have been proposed and more integration of component parts would assist in accelerating drug development.
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Affiliation(s)
- Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
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19
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Ogawa M, Sone D, Maruo K, Shimada H, Suzuki K, Watanabe H, Matsuda H, Mizusawa H. Analysis of risk factors for mild cognitive impairment based on word list memory test results and questionnaire responses in healthy Japanese individuals registered in an online database. PLoS One 2018; 13:e0197466. [PMID: 29772021 PMCID: PMC5957388 DOI: 10.1371/journal.pone.0197466] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/02/2018] [Indexed: 12/20/2022] Open
Abstract
Although the development of effective therapeutic drugs and radical treatment options for dementia and Alzheimer’s disease (AD) remains urgent, progress in recent clinical trials of AD drugs has been less than adequate. In order to advance the progress of clinical trials, it is necessary to establish more efficient methods of recruitment. In Japan, there are registration systems stratified by mild cognitive impairment and preclinical and clinical stages of early and advanced stage dementia, but there is no registration system for healthy individuals yet. Therefore, in the present study, we developed a large-scale, internet-based health registry to investigate factors associated with cognitive function among registered participants. A total of 1038 participants completed the initial questionnaire and word list memory test. Among these participants, 353 individuals completed a second questionnaire and memory test. Stepwise multiple regression analysis was performed using IBM SPSS version 23.0 for Windows at a statistical significance level of p<0.05. We found that mood, motivation, and a decreased ability to perform activities of daily living were significantly associated with cognitive function. The results of the present study suggest that maintaining social involvement is important to prevent decreases in physical activity, daily function, mood, and motivation.
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Affiliation(s)
- Masayo Ogawa
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Daichi Sone
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kazushi Maruo
- Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan
- University of Tsukuba, Tsukuba, Japan
| | - Hiroyuki Shimada
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Keisuke Suzuki
- Innovation Center for Clinical Research, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Hiroshi Watanabe
- Innovation Center for Clinical Research, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Hiroshi Matsuda
- Integrative Brain Imaging Center, National Center of Neurology and Psychiatry, Tokyo, Japan
- * E-mail:
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Cummings J, Lee G, Ritter A, Zhong K. Alzheimer's disease drug development pipeline: 2018. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2018; 4:195-214. [PMID: 29955663 PMCID: PMC6021548 DOI: 10.1016/j.trci.2018.03.009] [Citation(s) in RCA: 398] [Impact Index Per Article: 66.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Introduction Treatments for Alzheimer's disease (AD) are needed due to the growing number of individuals with preclinical, prodromal, and dementia forms of AD. Drug development for AD therapies can be examined by inspecting the drug development pipeline as represented on clinicaltrials.gov. Methods Clinicaltrials.gov was assessed as of January 30, 2018 to determine AD therapies represented in phase I, phase II, and phase III. Results There are 112 agents in the current AD treatment pipeline. There are 26 agents in 35 trials in phase III, 63 agents in 75 trials in phase II, and 23 agents in 25 trials in phase I. A review of the mechanisms of actions of the agents in the pipeline shows that 63% are disease-modifying therapies, 22% are symptomatic cognitive enhancers, and 12% are symptomatic agents addressing neuropsychiatric and behavioral changes. Trials in phase III are larger and longer than phase II or phase I trials, particularly those involving disease-modifying agents. Comparison with the 2017 pipeline shows that there are four new agents in phase III, 14 in phase II, and eight in phase I. Inspection of the use of biomarkers as revealed on clinicaltrials.gov shows that amyloid biomarkers are used as entry criterion in 14 phase III disease-modifying agent trials and 17 disease-modifying agent trials in phase II. Twenty-one trials of disease-modifying agents in phase II did not require biomarker confirmation for AD at trial entry. Discussion The AD drug development pipeline is slightly larger in 2018 than in 2017. Trials increasingly include preclinical and prodromal populations. There is an increase in nonamyloid mechanisms of action for drugs in earlier phases of drug development. Biomarkers are increasingly used in AD drug development but are not used uniformly for AD diagnosis confirmation.
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Affiliation(s)
- Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Garam Lee
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Aaron Ritter
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Kate Zhong
- Global Alzheimer Platform, Washington, DC, USA
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Doraiswamy PM, Narayan VA, Manji HK. Mobile and pervasive computing technologies and the future of Alzheimer's clinical trials. NPJ Digit Med 2018; 1:1. [PMID: 31304287 PMCID: PMC6550135 DOI: 10.1038/s41746-017-0008-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/12/2017] [Accepted: 09/12/2017] [Indexed: 12/16/2022] Open
Abstract
The rapid growth of mobile phones, automated speech recognizing personal assistants, and internet access among the elderly provides new opportunities for incorporating such technologies into clinical research and personalized medical care. Alzheimer's disease is a good test case given the need for early detection, the high rate of clinical trial failures, the need to more efficiently recruit patients for trials, and the need for sensitive and ecologically valid trial outcomes.
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Affiliation(s)
- P. Murali Doraiswamy
- Neurocognitive Disorders Program, Department of Psychiatry, Duke University Health System, and the Duke Institute for Brain Sciences, Durham, NC 27710 USA
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22
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Vidoni ED, Bothwell RJ, Burns JM, Dwyer JR. Novel recruitment models will drive Alzheimer's trial success. Alzheimers Dement 2017; 14:117-119. [PMID: 29156221 DOI: 10.1016/j.jalz.2017.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/02/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Eric D Vidoni
- University of Kansas Alzheimer's Disease Center, Fairway, KS, USA; Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA.
| | - Rebecca J Bothwell
- University of Kansas Alzheimer's Disease Center, Fairway, KS, USA; Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jeffrey M Burns
- University of Kansas Alzheimer's Disease Center, Fairway, KS, USA; Department of Neurology, University of Kansas Medical Center, Kansas City, KS, USA
| | - John R Dwyer
- Global Alzheimer's Platform Foundation, Washington, DC, USA
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23
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Nuño MM, Gillen DL, Dosanjh KK, Brook J, Elashoff D, Ringman JM, Grill JD. Attitudes toward clinical trials across the Alzheimer's disease spectrum. Alzheimers Res Ther 2017; 9:81. [PMID: 28978335 PMCID: PMC5628443 DOI: 10.1186/s13195-017-0311-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/20/2017] [Indexed: 12/04/2022]
Abstract
BACKGROUND Research has revealed that manifest Alzheimer's disease (AD) dementia is preceded by preclinical and prodromal phases during which pathology is accumulating but function remains intact. This understanding and concern that disease-modifying interventions initiated at the dementia stage may come too late in the neurodegenerative process to be successful has led to a paradigm shift in AD clinical trials. AD trials now enroll patients with mild cognitive impairment (MCI) and persons with no cognitive symptoms. Trial designs are similar to those enrolling dementia participants. We set out to test the hypothesis that attitudes towards trial design features differ among different potential AD trial populations. METHODS We sent a survey composed of 37 items assessing specific trial elements to 246 cognitively normal, MCI, and AD dementia participants at the University of California Los Angeles (UCLA) Alzheimer's Disease Research Center (ADRC), from whom we received 91 responses (37 cognitively normal, 32 MCI, and 22 dementia). To quantify willingness to enroll, we created three composite scenarios by summing responses and fitting proportional odds models with a binary outcome variable for whether patients were highly willing to participate in low-, moderate-, or high-risk and burden trials. RESULTS MCI participants less frequently correctly self-identified their diagnoses than those with dementia or normal cognition. Compared to dementia patients, the odds of participating in a low-risk, low-burden trial were 12% lower for MCI patients (odds ratio (OR) = 0.88, 95% confidence interval (CI) 0.23-3.29) and 70% lower (OR = 0.30, 95% CI 0.08-1.09) for cognitively normal participants. With increasing risk and burden, willingness to enroll decreased and the gap in relative willingness between diagnostic groups increased. In the medium-risk, medium-burden scenario, the estimated OR was 0.64 (95% CI 0.17-2.40) for MCI and 0.21 for the cognitively normal (95% CI 0.06-0.77). In the high-risk, high-burden scenario, the estimated OR indicated reduced willingness for MCI (OR = 0.27, 95% CI 0.06-1.15) and cognitively normal respondents (OR = 0.12, 95% CI 0.03-0.54). CONCLUSIONS These results suggest that AD trials enrolling predementia populations, especially those requiring frequent visits and implementing biomarker testing procedures, may encounter challenges to enrollment.
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Affiliation(s)
- Michelle M Nuño
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
- Department of Statistics, University of California, Irvine, CA, USA
| | - Daniel L Gillen
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA
- Department of Statistics, University of California, Irvine, CA, USA
| | - Kulwant K Dosanjh
- Division of General Internal Medicine/Health Services Research, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Jenny Brook
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - David Elashoff
- Department of Medicine, University of California, Los Angeles, CA, USA
| | - John M Ringman
- Department of Neurology, University of Southern California, Los Angeles, CA, USA
| | - Joshua D Grill
- Institute for Memory Impairments and Neurological Disorders, University of California, Irvine, CA, USA.
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA.
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Crous-Bou M, Minguillón C, Gramunt N, Molinuevo JL. Alzheimer's disease prevention: from risk factors to early intervention. ALZHEIMERS RESEARCH & THERAPY 2017; 9:71. [PMID: 28899416 PMCID: PMC5596480 DOI: 10.1186/s13195-017-0297-z] [Citation(s) in RCA: 371] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Due to the progressive aging of the population, Alzheimer’s disease (AD) is becoming a healthcare burden of epidemic proportions for which there is currently no cure. Disappointing results from clinical trials performed in mild–moderate AD dementia combined with clear epidemiological evidence on AD risk factors are contributing to the development of primary prevention initiatives. In addition, the characterization of the long asymptomatic stage of AD is allowing the development of intervention studies and secondary prevention programmes on asymptomatic at-risk individuals, before substantial irreversible neuronal dysfunction and loss have occurred, an approach that emerges as highly relevant. In this manuscript, we review current strategies for AD prevention, from primary prevention strategies based on identifying risk factors and risk reduction, to secondary prevention initiatives based on the early detection of the pathophysiological hallmarks and intervention at the preclinical stage of the disease. Firstly, we summarize the evidence on several AD risk factors, which are the rationale for the establishment of primary prevention programmes as well as revising current primary prevention strategies. Secondly, we review the development of public–private partnerships for disease prevention that aim to characterize the AD continuum as well as serving as platforms for secondary prevention trials. Finally, we summarize currently ongoing clinical trials recruiting participants with preclinical AD or a higher risk for the onset of AD-related cognitive impairment. The growing body of research on the risk factors for AD and its preclinical stage is favouring the development of AD prevention programmes that, by delaying the onset of Alzheimer’s dementia for only a few years, would have a huge impact on public health.
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Affiliation(s)
- Marta Crous-Bou
- Barcelonaβeta Brain Research Center-Pasqual Maragall Foundation, C/Wellington, 30, 08005, Barcelona, Spain
| | - Carolina Minguillón
- Barcelonaβeta Brain Research Center-Pasqual Maragall Foundation, C/Wellington, 30, 08005, Barcelona, Spain
| | - Nina Gramunt
- Barcelonaβeta Brain Research Center-Pasqual Maragall Foundation, C/Wellington, 30, 08005, Barcelona, Spain.,CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - José Luis Molinuevo
- Barcelonaβeta Brain Research Center-Pasqual Maragall Foundation, C/Wellington, 30, 08005, Barcelona, Spain. .,CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain.
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Krysinska K, Sachdev PS, Breitner J, Kivipelto M, Kukull W, Brodaty H. Dementia registries around the globe and their applications: A systematic review. Alzheimers Dement 2017; 13:1031-1047. [PMID: 28576507 PMCID: PMC6872163 DOI: 10.1016/j.jalz.2017.04.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/05/2017] [Accepted: 04/11/2017] [Indexed: 12/22/2022]
Abstract
Patient registries are valuable tools helping to address significant challenges in research, care, and policy. Registries, well embedded in many fields of medicine and public health, are relatively new in dementia. This systematic review presents the current situation in regards to dementia registries worldwide. We identified 31 dementia registries operating on an international, national, or local level between 1986 and 2016. More than half of the registries aimed to conduct or facilitate research, including preclinical research registries and registries recruiting research volunteers. Other dementia registries collected epidemiological or quality of care data. We present evidence of practical and economic outcomes of registries for research, clinical practice and policy, and recommendations for future development. Global harmonization of recruitment methods and minimum data would facilitate international comparisons. Registries provide a positive return on investment; their establishment and maintenance require ongoing support by government, policy makers, research funding bodies, clinicians, and individuals with dementia and their caregivers.
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Affiliation(s)
- Karolina Krysinska
- Faculty of Medicine, Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales (UNSW Sydney), NSW, Australia
| | - Perminder S Sachdev
- Faculty of Medicine, Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales (UNSW Sydney), NSW, Australia; Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales (UNSW Sydney), NSW, Australia; NPI, Euroa Centre, School of Psychiatry, UNSW Sydney, NSW, Australia
| | - John Breitner
- McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Department of Neurobiology, Karolinska Institutet, Care Sciences and Society (NVS), Huddinge, Sweden
| | - Walter Kukull
- National Alzheimer's Coordinating Center (NACC), University of Washington, Seattle, WA, USA
| | - Henry Brodaty
- Faculty of Medicine, Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales (UNSW Sydney), NSW, Australia; Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales (UNSW Sydney), NSW, Australia; NPI, Euroa Centre, School of Psychiatry, UNSW Sydney, NSW, Australia.
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Alzheimer's disease drug development pipeline: 2017. ALZHEIMERS & DEMENTIA-TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2017; 3:367-384. [PMID: 29067343 PMCID: PMC5651419 DOI: 10.1016/j.trci.2017.05.002] [Citation(s) in RCA: 272] [Impact Index Per Article: 38.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION There is an urgent need to develop new treatments for Alzheimer's disease (AD) and to understand the drug development process for new AD therapies. METHODS We assessed the agents in the AD pipeline as documented in clinicaltrials.gov for phase I, phase II, and phase III, accessed 1/5/2017. RESULTS There are 105 agents in the AD treatment development pipeline, of which 25 agents are in 29 trials in phase I, 52 agents are in 68 trials in phase II, and 28 agents are in 42 trials in phase III. Seventy percent of drugs in the AD pipeline are disease-modifying therapies (DMTs). Fourteen percent are symptomatic cognitive enhancers, and 13% are symptomatic agents addressing neuropsychiatric and behavioral changes (2% have undisclosed mechanisms). Most trials are sponsored by the biopharmaceutical industry. Trials include patients with preclinical AD (cognitively normal with biomarker evidence of AD), prodromal AD (mild cognitive symptoms and biomarker evidence of AD), and AD dementia. Biomarkers are included in many drug development programs particularly those for DMTs. Thirteen of 46 phase II DMT trials have amyloid imaging as an entry criterion, and 10 of 28 phase III trials incorporate amyloid imaging for diagnosis and entry. A large number of participants are needed for AD clinical trials; in total, 54,073 participants are required for trials spanning preclinical AD to AD dementia. When compared with the 2016 pipeline, there are eight new agents in phase I, 16 in phase II, and five in phase III. DISCUSSION The AD drug development pipeline has 105 agents divided among phase I, phase II, and phase III. The trials include a wide range of clinical trial populations, many mechanisms of action, and require a substantial number of clinical trial participants. Biomarkers are increasingly used in patient identification and as outcome measures, particularly in trials of DMTs.
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SUZUKI K, IWATA A, IWATSUBO T. The past, present, and future of disease-modifying therapies for Alzheimer's disease. PROCEEDINGS OF THE JAPAN ACADEMY. SERIES B, PHYSICAL AND BIOLOGICAL SCIENCES 2017; 93:757-771. [PMID: 29225305 PMCID: PMC5790756 DOI: 10.2183/pjab.93.048] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The development of disease-modifying therapies for Alzheimer's disease (AD) is an urgent issue. Progress in the understanding of AD pathophysiology based on the amyloid hypothesis has led to the development of numerous candidate disease-modifying therapies over the past 15 years. The therapeutic target, amyloid β (Aβ), starts to accumulate in AD brains long before the onset of cognitive decline. γ-secretase inhibitors, γ-secretase modulators, and β-secretase inhibitors aim to reduce the production of toxic Aβ species by modifying the processing of amyloid precursor protein. Another strategy is to eliminate accumulated Aβ by active or passive immunotherapeutic approaches. Therapeutic strategies targeting tau protein are also currently emerging. Despite these efforts, successful disease-modifying therapies for AD have not yet been developed. Recently, very early interventional trials targeting preclinical stages of AD have begun; the paradigm shift in AD therapies from cure to prevention could be key to the success of disease modification.
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Affiliation(s)
- Kazushi SUZUKI
- Unit for Early and Exploratory Clinical Development, the University of Tokyo Hospital, Tokyo, Japan
- Department of Neurology, School of Medicine, the University of Tokyo, Tokyo, Japan
- Correspondence should be addressed: K. Suzuki or T. Iwatsubo, Unit for Early and Exploratory Clinical Development, the University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan (e-mail: or )
| | - Atsushi IWATA
- Department of Neurology, School of Medicine, the University of Tokyo, Tokyo, Japan
| | - Takeshi IWATSUBO
- Unit for Early and Exploratory Clinical Development, the University of Tokyo Hospital, Tokyo, Japan
- Department of Neuropathology, School of Medicine, the University of Tokyo, Tokyo, Japan
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Touchon J, Rosenbaum J, Aisen P, Andrieu S, Carrillo MC, Ceccaldi M, Dartiques JF, Feldman H, Gabelle A, Isaac M, Fitten LJ, Sperling RA, Vellas B, Tariot P, Weiner M. Editorial: Collaborative Efforts to Prevent Alzheimer's Disease. J Nutr Health Aging 2017; 21:1072-1074. [PMID: 29188862 DOI: 10.1007/s12603-017-0961-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J Touchon
- Jacques Touchon, University Hospital of Montpellier, 34025 Montpellier Cedex 5, France,
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Cummings J, Aisen PS, DuBois B, Frölich L, Jack CR, Jones RW, Morris JC, Raskin J, Dowsett SA, Scheltens P. Drug development in Alzheimer's disease: the path to 2025. Alzheimers Res Ther 2016; 8:39. [PMID: 27646601 PMCID: PMC5028936 DOI: 10.1186/s13195-016-0207-9] [Citation(s) in RCA: 281] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The global impact of Alzheimer's disease (AD) continues to increase, and focused efforts are needed to address this immense public health challenge. National leaders have set a goal to prevent or effectively treat AD by 2025. In this paper, we discuss the path to 2025, and what is feasible in this time frame given the realities and challenges of AD drug development, with a focus on disease-modifying therapies (DMTs). Under the current conditions, only drugs currently in late Phase 1 or later will have a chance of being approved by 2025. If pipeline attrition rates remain high, only a few compounds at best will meet this time frame. There is an opportunity to reduce the time and risk of AD drug development through an improvement in trial design; better trial infrastructure; disease registries of well-characterized participant cohorts to help with more rapid enrollment of appropriate study populations; validated biomarkers to better detect disease, determine risk and monitor disease progression as well as predict disease response; more sensitive clinical assessment tools; and faster regulatory review. To implement change requires efforts to build awareness, educate and foster engagement; increase funding for both basic and clinical research; reduce fragmented environments and systems; increase learning from successes and failures; promote data standardization and increase wider data sharing; understand AD at the basic biology level; and rapidly translate new knowledge into clinical development. Improved mechanistic understanding of disease onset and progression is central to more efficient AD drug development and will lead to improved therapeutic approaches and targets. The opportunity for more than a few new therapies by 2025 is small. Accelerating research and clinical development efforts and bringing DMTs to market sooner would have a significant impact on the future societal burden of AD. As these steps are put in place and plans come to fruition, e.g., approval of a DMT, it can be predicted that momentum will build, the process will be self-sustaining, and the path to 2025, and beyond, becomes clearer.
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Affiliation(s)
- Jeffrey Cummings
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV USA
| | - Paul S. Aisen
- University of Southern California, San Diego, CA USA
| | - Bruno DuBois
- Institute for Memory and Alzheimer’s Disease (IM2A) and ICM, Salpêtrière University Hospital, Paris University, Paris, France
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Roy W. Jones
- The Research Institute for the Care of Older People (RICE), Royal United Hospital, Bath, UK
| | - John C. Morris
- Knight Alzheimer Disease Research Center, Washington University School of Medicine, St Louis, MO USA
| | | | | | - Philip Scheltens
- Department of Neurology & Alzheimer Center, VU University Medical Center, Amsterdam, Netherlands
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