Roundup from Clinical Trials on Alzheimer’s Disease (CTAD) Day One: Biogen, Blood Pressure Control

By | December 5th, 2019

SAN DIEGO — A highly anticipated Alzheimer’s conference opened here last night with reports about a powerful new drug for treating dementia-related delusions and promising developments in research about blood pressure control and dementia.

Underlying all the reports of highly technical research data, however, was anticipation of a blockbuster announcement on Thursday from Biogen and its partner Eisai about the effectiveness of aducanumab, an experimental Alzheimer’s drug. 

Only six weeks ago, Biogen stunned the Alzheimer’s community by saying it would attempt to revive aducanumab, which it had summarily killed in March when the company announced the drug had failed a futility analysis. In October, however, Biogen said that new data had emerged from clinical trials on aducanumab that showed the drug was effective in treating Alzheimer’s.

In an opening keynote presentation on interpreting recent results in Alzheimer’s disease treatment, Dr. Steven Salloway referenced the wild swings on aducanumab and joked that “it’s been a really smooth ride this year and it should be easy to make sense of what’s been going on.”

Salloway, the Chief of Neurology and Director of the Memory and Aging Program at Butler Hospital in Providence, RI, said that aducanumab appears to have made an “unprecedented comeback.”

“I don’t recall seeing a drug that looked like it was headed for the dustbin coming back and heading to the FDA in such a short time,” Salloway said.

Lifetime Achievement

The conference opened with the presentation of a lifetime achievement award to Zaven Khachaturian, widely seen as the father of modern research into Alzheimer’s.

Introducing Khachaturian, Paul Aisen, Director of the Alzheimer’s Therapeutic Research Institute at the Keck School of Medicine at USC San Diego, said there is no other “name that has the same significance to our field.”

“As our field continued to mature,” Aisen said, “Zaven has been present at every step as a guiding figure, as a visionary.”

From 1977 through 1995, Khachaturian served as the Director of Alzheimer’s Research at the National Institutes on Health, and is credited with building the research infrastructure and funding that has brought the field to where it is today.

“In the late 1960s and 70s,” Khachaturian said, “we were facing some incredible obstacles to getting a national program going.”

Among the challenges, he said, was low interest in aging research and a severe lack of funding.

The scientific community’s mindset at the time, Khachaturian said, was “what’s the point of doing aging research, they are going to die anyway.”

That mindset obviously has changed with hundreds of thousands of researchers around the world exploring Alzheimer’s and other neurodegenerative disorders.

“We still face historically great obstacles,” Khachaturian said. “The most important obstacle is changing the mindset about the disease, which is a far more complex problem than we initially thought.”

Saying that he is “humbled by the challenges that continue to face us,” Khachaturian concluded that he is “very optimistic that we can solve this problem if we hang together and continue to do good science.”

Blood Pressure Control

The big report from the conference’s opening night on Wednesday was news about its success in treating dementia-related delusions and hallucinations with the drug pimavanserin. But continuing research into the impact on Alzheimer’s with efforts to aggressively control blood pressure was not as clear cut.

Overall results of a massive blood pressure trial started in 2010 have demonstrated that targeting a systolic blood pressure of 120 (as opposed to 140) reduces cardiovascular disease as well as the occurrence of mild cognitive impairment. But the data is less clear on the impact of intensive blood pressure control on cognitive impairment and the ultimate development of dementia in older adults. 

The study, dubbed SPRINT MIND, has led to a consensus that aggressively targeting blood pressure not only helps the heart but it also helps the brain.

In three highly technical presentations at the conference, researchers were questioned about some of the underlying statistical analysis of the data. 

No one, however, doubted the study’s overall conclusions: what is good for the heart is good for the head. Helping to prevent new cases of mild cognitive impairment will lead to fewer people living with Alzheimer’s and other dementias.

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