Treatment for Alzheimer's Disease: Approved drugs
This section is offshoot of my gathering of news items about memory. I am not a medical expert. My background is in psychology. The information I have gathered here should not be taken as providing any advice.
You can check out words you don't know in the glossary of terms used in Alzheimer's research
Approved Alzheimer's drugs
November 2007
Drugs may not delay onset of dementia
A review of six
clinical trials that had addressed the use of cholinesterase inhibitors (donepezil,
rivastigmine and galantamine) with MCI patients has found that in none of the
trials did the use of the drugs significantly reduce the rate of progression
from MCI to dementia.
Full text available at
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040338
The report appeared in the open access journal PLOS Medicine.
Full reference
http://www.eurekalert.org/pub_releases/2007-11/plos-dmn112207.php
August 2005
Negative review of recommended Alzheimer's drugs
A review of the 22 published, double-blind, randomised trials of the
three
cholinesterase
inhibitors currently recommended for Alzheimer’s disease (donepezil,
rivastigmine, and
galantamine) has found
considerable flaws in the methodology of all trials, and concluded that
“Because of flawed methods and small clinical benefits, the scientific
basis for recommendations of cholinesterase inhibitors for the treatment
of Alzheimer's disease is questionable.”
The study was reported in the August 6 issue of the
British Medical Journal.
Full reference
July 2005
Anti-inflammatory function of Alzheimer's disease drugs revealed
Current Alzheimer’s drugs focus on preventing the breakdown
of acetylcholine. Acetylcholine-producing cells are among the
first to die in Alzheimer's patients. Research has also shown
that the brains of Alzheimer's patients are characterized by
excessive immune activation and inflammation, which are induced
by overproduction of an inflammation-producing protein called
interleukin-1 and related compounds. Now a new study has found
that current Alzheimer's drugs cause a marked reduction in the
production of interleukin-1. The findings suggest a new
interpretation of why acetylcholine is important; when the
acetylcholine increases (as a result of the drug), there is a
reduction of the production of interleukin-1. The study also
describes the use of a new drug (EN101) which produces these
effects in a more efficient way than known heretofore by
destroying the molecular antecedent (messenger RNA) of the
enzyme, rather than simply blocking the enzyme's activity.
The study was published in the May issue of
Annals of Neurology.
Full reference
http://www.eurekalert.org/pub_releases/2005-07/thuo-afo072805.htm
February 2005
Drugs used to treat Alzheimer's in nursing homes are worsening sufferers' illness
A study of 93 patients with dementia has found that
quetiapine, an anti-psychotic drug commonly used in nursing
homes to treat agitation and related symptoms in people with
Alzheimers' disease, actually worsens patients' illness,
significantly speeding up their rate of cognitive decline.
Unfortunately, quetiapine had been regarded as one of the
safer of the antipsychotic drugs available. There have been
safety concerns with the two most commonly used
antipsychotic drugs in people with dementia, risperidone and
olanzapine, because of increased risk of stroke.
Participants in the trial who were taking rivastigmine
showed little or no worsening of their illness. Neither drug
had any effect on agitation.
The paper appeared in the April 16 issue of the
British Medical Journal.
Full reference
http://www.eurekalert.org/pub_releases/2005-02/bmj-dut021605.htm
February 2004
Research clarifies how Alzheimer's medicines work
New research clarifies how cholinesterase
inhibitors alleviate mild-to-moderate Alzheimer's. When scientists chemically
blocked receptors for an important neurotransmitter called acetylcholine, even
healthy young people found it significantly harder to learn and remember –
especially in the face of interference. Cholinesterase inhibitors slow the
breakdown of acetylcholine. The finding also helps explain why Parkinson's
disease, dementia due to multiple strokes, multiple sclerosis and schizophrenia,
are all also associated with memory problems — all these conditions, like
Alzheimer’s, are associated with lower levels of acetylcholine in the brain.
The study appeared in the February issue of
Behavioral Neuroscience.
Full reference
(Full text of the article is available at
http://www.apa.org/journals/bne/press_releases/february_2004/bne1181223.html
)
http://www.eurekalert.org/pub_releases/2004-02/apa-rch020904.htm
Memantine
January 2008
Memantine works differently than thought
New research shows that the drug memantine, praised as
"the first and only representative of a new class of Alzheimer drugs", in fact
works similar to other existing compounds, and although the data do confirm that
memantine shows promising aspects for the treatment of Alzheimer’s, this is only
in a narrow concentration range. Its complex pharmacological profile requires
careful considerations concerning suitable doses and suitable patient groups.
The study was published in the December issue of the Journal of Alzheimer's Disease.
Full reference
http://www.eurekalert.org/pub_releases/2008-01/ip-maa011008.php
April 2005
Some benefit from memantine for moderate-to-severe Alzheimer’s
A review of nine published studies comprising 2,339 participants
has concluded that memantine has a small but significant cognitive benefit for
moderate-to-severe Alzheimer’s patients. It also seems to prevent the onset of
agitation. Although there was some indication of benefit for those with mild to
moderate Alzheimer’s, the effects were not significant. Researchers caution that
the drug treats the symptoms only, slowing the progress of the disease only.
The review appears in the April issue of
The Cochrane Library.
http://www.eurekalert.org/pub_releases/2005-04/cfta-sap041505.htm
January 2004
New drug approved for moderate to severe Alzheimer's
The FDA recently approved memantine for treatment of moderate
to severe Alzheimer’s. The drug has been used for some 20 years
in Germany. While memantine significantly improved performance
in Alzheimer’s sufferers in studies, the effect, as with all
Alzheimer’s drugs currently in use, is small.
The report appeared in the 21 January issue of the
Journal of the American Medical Association.
Full reference
http://www.eurekalert.org/pub_releases/2004-01/uorm-jsc012004.htm
http://www.eurekalert.org/pub_releases/2004-01/jaaj-ndi011504.htm
April 2003
New Drug for Moderate-to-Severe Alzheimer's
Four drugs — donepezil, galantamine, rivastigmine, and tacrine —
are approved for treatment of mild-to-moderate Alzheimer's disease in the U.S.,
but there are no approved treatments for severe AD. Now an industry-sponsored
study has examined memantine for this use. The study involved 252 patients with
moderate-to-severe AD, over a period of 28 weeks. Patients were evaluated on 7
tests of cognition, functional capacity, and behavior. Outcomes were
significantly better with memantine than with placebo on 4 of these scales, and
no significant adverse events were noted. It is not clear yet how clinically
meaningful these small improvements are. Memantine has been approved for use in
Europe.
The report appeared in the April 3 issue of the New
England Journal of Medicine.
Full reference
http://www.eurekalert.org/pub_releases/2003-04/nyum-dsp032603.htm
Reminyl
August 2005
Negative review of recommended Alzheimer's drugs
A review of the 22 published, double-blind, randomised trials of the
three
cholinesterase
inhibitors currently recommended for Alzheimer’s disease (donepezil,
rivastigmine, and
galantamine) has found
considerable flaws in the methodology of all trials, and concluded that
“Because of flawed methods and small clinical benefits, the scientific
basis for recommendations of cholinesterase inhibitors for the treatment
of Alzheimer's disease is questionable.”
The study was reported in the August 6 issue of the
British Medical Journal.
Full reference
November 2004
Reduced risk of institutionalization in patients with dementia
A study of 596 patients from 7 countries found that dementia
patients receiving long-term treatment with REMINYL (more than
36 months) may be able to stay at home for longer compared to
those receiving treatment for shorter periods of time. Experts
believe the long-term clinical efficacy of galantamine may be
because as well as enhancing levels of the neurotransmitter
acetylcholine, it also (unlike other treatments), has a
modulating effect on the brain's nicotinic receptors, which is
believed to increase their effectiveness. Nicotinic receptors
are thought to play a key role in attention, memory and
learning.
The results of this study were presented at the 17th European
Congress of Neuropsychopharmacology, Stockholm, Sweden.
Reference
http://www.eurekalert.org/pub_releases/2004-11/rc-rro110904.htm
April 2004
Patients' medications eases caregiver distress
In a new analysis of an earlier study, researchers have
discovered that the drugs currently used to alleviate the
symptoms of Alzheimer’s not only help confusion and memory loss,
but also alleviates or delays symptoms like agitation,
depression, and psychosis, and thus have flow-on effects of
alleviating the burden on caregivers. For patients not already
exhibiting behavioral problems, treatment with galantamine
delayed their symptoms for more than three years on average.
This is added impetus to treat patients with dementia with
cholinesterase inhibitors as early as possible.
The report appeared in the March issue of the
American Journal of Psychiatry.
Full reference
http://www.eurekalert.org/pub_releases/2004-04/uorm-crt040504.htm
April 2002
ARICEPT better than Reminyl for cognition
Results from the first study to
directly compare the two Alzheimer drugs, ARICEPT® (donepezil HCl tablets) and
Reminyl® (galantamine HBr tablets), found that ARICEPT-treated patients showed
significant benefit over patients receiving Reminyl®. Not only were cognitive
benefits greater, but ARICEPT® was tolerated significantly better.
The study was presented at the 7th International
Geneva/Springfield Symposium on Advances in Alzheimer Therapy (AAT) in Geneva,
Switzerland.
http://www.eurekalert.org/pub_releases/2002-04/pn-asi040302.htm
September 2001
Reminyl may help those with vascular dementia
Reminyl (galantamine) may be effective in treating
dementia in patients with
cerebrovascular disease, such as stroke. Data from a study presented at the XVII
World Congress of Neurology show that Reminyl improves memory, orientation and
language skills of patients with vascular dementia or a combination of
Alzheimer's disease and cerebrovascular disease ("mixed" dementia) for at least
12 months. The results also showed that Reminyl improved or maintained the
ability of these individuals to perform normal activities of daily living, such
as bathing, dressing and doing housework. However, Reminyl is not yet approved
for the treatment of vascular dementia.
http://www.eurekalert.org/pub_releases/2001-06/K-DsnA-1806101.htm
Potential impact of Reminyl on caregiver 'burden' in Alzheimer's disease
Several
studies presented at the Tenth Congress of the International Psychogeriatric
Association (IPA) assessed the impact of Reminyl treatment on patient
functioning by exploring the resulting impact on time required of family
caregivers. One study of 435 patients from Europe and Canada, focused on the
time caregivers spent supervising their family members or assisting them with
activities of daily living, such as dressing and bathing. It was found that the
time required to supervise patients who received a placebo increased by
approximately two hours per day over the six months, while the time spent
supervising individuals who took Reminyl did not increase significantly. In
addition, the time that caregivers spent assisting patients on placebo with
daily-living activities increased steadily throughout the trial, totalling an
average of 23 extra minutes per day by the end of six months. On the other hand,
caregivers of patients taking Reminyl reported a decrease in the amount of time
spent assisting their charges by an average of 38 minutes per day.
A different study focused on caregiver distress and analysed data from a
five-month study of 286 U.S. patients. Participating caregivers rated the degree
of distress they experienced in response to 10 types of patient symptoms, such
as hallucinations, delusions and agitation. The analysis found that after five
months, distress significantly increased among those caring for patients who
took placebo. In contrast, distress scores were not significantly different at
the end of the study than at the beginning for those caring for persons who
received Reminyl.
http://www.eurekalert.org/pub_releases/2001-09/k-sod091301.htm
May 2001
Galantamine therapy shows sustained cognitive benefits for Alzheimer's patients
Previous studies have demonstrated the benefits of
galantamine (Reminyl™) treatment in terms of efficacy and safety in the
short-term. A recent study followed 636 Alzheimer’s patients over two years, and
found that patients receiving galantamine throughout the study maintained
cognitive benefits, while the placebo comparison group declined. Moreover, the
cognitive benefits of galantamine increased over time, relative to the predicted
rates of decline in untreated patients.
The study was presented at the American Academy of Neurology's 53rd Annual
Meeting in Philadelphia.
http://www.eurekalert.org/pub_releases/2001-05/AAoN-Gtss-0905101.htm
http://my.webmd.com/condition_center_content/alz/article/1728.79858
March 2001
Another drug for Alzheimer's sufferers
Another drug for Alzheimer's sufferers has been approved by the FDA. Reminyl® is of the same nature as the other three medications already available( Cognex®, Aricept®, and Exelon®). These are all cholinesterase inhibitors; they interfere with the action of an enzyme that would otherwise reduce the brain's supply of acetylcholine, a chemical messenger that is essential for thought processes and nerve function.
Aricept
July 2007
Drug improves symptoms of severe Alzheimer's disease
A six-month study involving 343 people with severe
Alzheimer’s disease has found that donepezil, a drug used to treat mild to
moderate Alzheimer’s, stabilized or improved cognitive function in 63% of those
taking donepezil compared to 39% of those taking placebo. Compared to the
placebo group, those taking donepezil showed improvement in memory, language,
attention, and recognizing one’s name. The donepezil group also showed less of a
decline in social interaction, skills needed to complete a jigsaw puzzle, and
arranging sentences compared to the placebo group.
The study was published in the July 31 issue of Neurology.
Full reference
http://www.eurekalert.org/pub_releases/2007-07/aaon-dis072407.php
July 2006
Donezepil slows brain deterioration for some on road to Alzheimer's
According to a new study, the drug donepezil measurably (but still
only slightly) slows the rate of hippocampal shrinkage in patients with
mild cognitive impairment (a pre-Alzheimer's condition) who carried the
apolipoprotein E4 (APOE 4) gene variant. The study involved 131 patients
with mild cognitive impairment. For APOE 4 carriers, the rate of
hippocampal atrophy was 4.5% per year, versus 6.14% in placebo-treated
patients. Rates of shrinkage for cognitively normal people in their late
70s are approximately 1.4 percent per year. Vitamin E had no significant
effect on atrophy for any patients.
Findings were presented July 17 at the Alzheimer's Association
International Conference on Alzheimer's Disease and Related Disorders in
Madrid, Spain.
http://www.eurekalert.org/pub_releases/2006-07/mc-msd071306.htm
August 2005
Negative review of recommended Alzheimer's drugs
A review of the 22 published, double-blind, randomised trials of the
three
cholinesterase
inhibitors currently recommended for Alzheimer’s disease (donepezil,
rivastigmine, and
galantamine) has found
considerable flaws in the methodology of all trials, and concluded that
“Because of flawed methods and small clinical benefits, the scientific
basis for recommendations of cholinesterase inhibitors for the treatment
of Alzheimer's disease is questionable.”
The study was reported in the August 6 issue of the
British Medical Journal.
Full reference
June 2005
New memory drug works best in combination with older drug
An experimental drug – a compound known as SGS742 – has
been successful in animal studies in improving memory, and
is now in human clinical trials. The drug works by blocking
certain chemicals that interfere with memory formation, thus
enabling better acquisition and retention of new
information. It alters the activity of gene control
machinery that is important for memory consolidation. It was
most effective when used in conjunction with Aricept, an
established Alzheimer’s drug.
The findings were described in the June issue of
Neuropharmacology.
Full reference
http://www.eurekalert.org/pub_releases/2005-06/jhu-nmd060905.htm
April 2005
Clinical diagnosis of Alzheimer's may be delayed with donepezil
In a study of people with mild cognitive impairment,
those who took the drug donepezil were at reduced risk of
progressing to a diagnosis of Alzheimer's during the first
years of the trial, but by the end of the 3-year study there
was no benefit from the drug. Of the 769 participants, 212
developed possible or probable Alzheimer’s within the 3-year
study period; the donepezil group's risk of progression to a
diagnosis of Alzheimer’s was reduced by 58% one year into
the study, and 36% at 2 years, but no risk reduction at the
end of three years. Vitamin E was also tested in the study
and was found to have no effect at any point in the study.
The findings were reported in the April 14 online issue of
The New England Journal of Medicine, and will appear
in the June 9 print issue.
Full reference
http://www.eurekalert.org/pub_releases/2005-04/nioa-cdo041205.htm
http://www.eurekalert.org/pub_releases/2005-04/mc-dia041105.htm
July 2004
Donepezil may have short-term benefit for mild cognitive impairment
Preliminary data from a recently completed clinical trial of
769 patients with mild cognitive impairment indicates that those
taking the drug donepezil were at reduced risk of progressing to
Alzheimer's disease for 18 months. The reduced risk disappeared
after 18 months, and by the end of the 3-year study, the
probability of progressing to Alzheimer’s was the same in the
two groups. The study compared donepezil, vitamin E, or placebo.
There was no apparent benefit from vitamin E.
http://www.eurekalert.org/pub_releases/2004-07/nioa-dmh071504.htm
http://www.eurekalert.org/pub_releases/2004-07/mc-tcs071504.htm
June 2004
Doubt over effectiveness of cholinesterase inhibitors for treatment of Alzheimer's
A study involving 565 Alzheimer’s patients has found that
while donepezil did improve tests of mental and functional
ability over the first 2 years of treatment, the improvement was
slight, and there was no significant delay in
institutionalization or progression of disability. There were
also no differences between donepezil and placebo in behavioral
and psychological symptoms, formal care costs, unpaid caregiver
time, adverse events or deaths, or between the two doses of
donepezil used in the study.
The study was reported in the 26 June issue of
The Lancet.
Full reference
http://www.eurekalert.org/pub_releases/2004-06/l-doe062304.htm
April 2003
ARICEPT® helpful in treating patients with severe Alzheimer's
A new analysis from the Moderate to Severe Alzheimer's
Disease Study (MSAD), previously published in Neurology in August 2001, suggests
that ARICEPT® may also be helpful to those with more advanced Alzheimer’s. The
study involved 145 patients with severe Alzheimer's disease who were residing in
the community or in assisted living settings. Patients requiring total nursing
care were ineligible. ARICEPT®-treated patients showed cognitive improvement ;
improved or stable global function; less decline on activities of daily living;
fewer behavioral disturbances. Some 10% had to drop out because of adverse
reactions.
The data were presented at the American Academy of Neurology (AAN) 55th Annual
Meeting.
http://www.eurekalert.org/pub_releases/2003-04/ei-nsf040303.htm
April 2002
ARICEPT better than Reminyl for cognition
Results from the first study to
directly compare the two Alzheimer drugs, ARICEPT® (donepezil HCl tablets) and
Reminyl® (galantamine HBr tablets), found that ARICEPT-treated patients showed
significant benefit over patients receiving Reminyl®. Not only were cognitive
benefits greater, but ARICEPT® was tolerated significantly better.
The study was presented at the 7th International
Geneva/Springfield Symposium on Advances in Alzheimer Therapy (AAT) in Geneva,
Switzerland.
http://www.eurekalert.org/pub_releases/2002-04/pn-asi040302.htm
September 2001
Aricept helpful for those with moderate to severe Alzheimer's
The benefits of ARICEPT® (donepezil
hydrochloride) may extend into more advanced stages of Alzheimer's disease than
previously investigated, according to a first-ever published study of ARICEPT®
in patients with moderate to severe Alzheimer's disease, which found significant
benefits in patient function, cognition, behavior, and activities of daily
living, with very good tolerability. ARICEPT® is approved for the treatment of
symptoms of mild to moderate Alzheimer’s disease. Further study of ARICEPT® in
patients with severe Alzheimer's disease is currently under way.
The study was published in the 28 August issue of
Neurology.
http://www.eurekalert.org/pub_releases/2001-08/pn-fps082701.htm
August 2001
Alzheimer's patients taking Aricept maintain daily activities longer
In a 54-week U.S. study of 415 people
with mild to moderate Alzheimer's, patients who took the drug donepezil
maintained their level of functioning in everyday activities such as shopping
and fixing meals, 72 percent longer than those who received a placebo did. The
study measured the amount of time before patients' functioning declined based on
a clinical rating scale. Those taking donepezil declined, on average, five
months later than the people taking the placebo.
Another study found that patients with mild to moderate Alzheimer's disease
taking placebo declined by about twice as much as those taking donepezil, based
on a scale of cognitive ability, functioning in daily activities and other
factors. The one-year study involved 286 people in Scandinavia and the
Netherlands.
The studies were published in the August 14 issue of
Neurology.
http://www.eurekalert.org/pub_releases/2001-08/aaon-apt080601.htm
October 2000
The drug Aricept might be more effective for Alzheimers sufferers than previously thought
A new study has demonstrated that the
drug Aricept® can "switch on" brain cells thought to be irreparably damaged in
Alzheimers sufferers. Previous research suggested Aricept had no such dramatic
effects. The new findings may enable more effective use to be made of the drug.
www.guardian.co.uk/Archive/Article/0,4273,4080005,00.html
Exelon
August 2005
Negative review of recommended Alzheimer's drugs
A review of the 22 published, double-blind, randomised trials of the
three
cholinesterase
inhibitors currently recommended for Alzheimer’s disease (donepezil,
rivastigmine, and
galantamine) has found
considerable flaws in the methodology of all trials, and concluded that
“Because of flawed methods and small clinical benefits, the scientific
basis for recommendations of cholinesterase inhibitors for the treatment
of Alzheimer's disease is questionable.”
The study was reported in the August 6 issue of the
British Medical Journal.
Full reference
February 2005
Drugs used to treat Alzheimer's in nursing homes are worsening sufferers' illness
A study of 93 patients with dementia has found that
quetiapine, an anti-psychotic drug commonly used in nursing
homes to treat agitation and related symptoms in people with
Alzheimers' disease, actually worsens patients' illness,
significantly speeding up their rate of cognitive decline.
Unfortunately, quetiapine had been regarded as one of the
safer of the antipsychotic drugs available. There have been
safety concerns with the two most commonly used
antipsychotic drugs in people with dementia, risperidone and
olanzapine, because of increased risk of stroke.
Participants in the trial who were taking rivastigmine
showed little or no worsening of their illness. Neither drug
had any effect on agitation.
The paper appeared in the April 16 issue of the
British Medical Journal.
Full reference
http://www.eurekalert.org/pub_releases/2005-02/bmj-dut021605.htm
June 2003
Exelon more effective than thought
Exelon ® (rivastigmine tartrate) is one of the drugs used to treat the symptoms
of mild-to-moderate Alzheimer’s. A new study suggests that the effects of Exelon
might be more significant than was thought — it may be able to delay progression
of the disease. The study found that 26 weeks after discontinuing treatment ,
those who had been on Exelon showed less cognitive decline than patients who had
previously taken a placebo.
The study appeared in the June issue of Archives of
Neurology.
Full reference
http://www.eurekalert.org/pub_releases/2003-06/iu-mms061703.htm
November 2000
Exelon found to reduce cognitive decline in mild to moderate Alzheimer's patients
A one-year study found
rivastigmine tartrate (Exelon®)
reduces the cognitive decline of people with mild to moderate Alzheimer's
disease. 545 patients completed the initial six-month phase of the trial and 532
then agreed to extend the trial another six months. Patients who received the
higher dose of rivastigmine from the beginning had higher cognitive scores at
the end than those patients who received a placebo or the lower dose during the
first six months. This suggests early treatment with a high dose may provide
benefits that are lost if treatment is delayed.
The study was published in the November issue of
European Neurology.
http://www.eurekalert.org/pub_releases/2000-11/IU-Rtrc-0811100.htm
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