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Published in: Alzheimer's Research & Therapy 1/2016

Open Access 01-12-2016 | Review

Drug development in Alzheimer’s disease: the path to 2025

Authors: Jeffrey Cummings, Paul S. Aisen, Bruno DuBois, Lutz Frölich, Clifford R. Jack Jr, Roy W. Jones, John C. Morris, Joel Raskin, Sherie A. Dowsett, Philip Scheltens

Published in: Alzheimer's Research & Therapy | Issue 1/2016

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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.
Literature
2.
go back to reference Vradenburg G. A pivotal moment in Alzheimer’s disease and dementia: how global unity of purpose and action can beat the disease by 2025. Expert Rev Neurother. 2015;15:73–82. Erratum: Expert Rev Neurother. 2015;15:459.CrossRefPubMed Vradenburg G. A pivotal moment in Alzheimer’s disease and dementia: how global unity of purpose and action can beat the disease by 2025. Expert Rev Neurother. 2015;15:73–82. Erratum: Expert Rev Neurother. 2015;15:459.CrossRefPubMed
4.
go back to reference Schneider LS, Mangialasche F, Adreasen N, Feldman H, Giacobini E, Jones R, et al. Clinical trials and late-stage drug development for Alzheimer’s disease: an appraisal from 1984 to 2014. J Intern Med. 2014;275:251–83.CrossRefPubMedPubMedCentral Schneider LS, Mangialasche F, Adreasen N, Feldman H, Giacobini E, Jones R, et al. Clinical trials and late-stage drug development for Alzheimer’s disease: an appraisal from 1984 to 2014. J Intern Med. 2014;275:251–83.CrossRefPubMedPubMedCentral
5.
go back to reference Cummings JL, Morstorf T, Zhong K. Alzheimer’s disease drug-development pipeline: few candidates, frequent failures. Alz Res Ther. 2014;6:37.CrossRef Cummings JL, Morstorf T, Zhong K. Alzheimer’s disease drug-development pipeline: few candidates, frequent failures. Alz Res Ther. 2014;6:37.CrossRef
7.
go back to reference Siemers E. Drug development in AD: point of view from the industry. J Prev Alz Dis. 2015;2:216–8. Siemers E. Drug development in AD: point of view from the industry. J Prev Alz Dis. 2015;2:216–8.
8.
go back to reference Henley DB, Sundell KL, Sethuraman G, Dowsett SA, May PC. Safety profile of semagacestat, a gamm-secretase inhibitor: IDENTITY trial findings. Curr Med Res Opin. 2014;10:2021–32.CrossRef Henley DB, Sundell KL, Sethuraman G, Dowsett SA, May PC. Safety profile of semagacestat, a gamm-secretase inhibitor: IDENTITY trial findings. Curr Med Res Opin. 2014;10:2021–32.CrossRef
9.
go back to reference Sugino H, Watanabe A, Amada N, Yamamoto M, Ohgi Y, Kostic D, Sanchez R. Global trends in Alzheimer disease clinical development: increasing the probability of success. Clin Ther. 2015;37:1632–42.CrossRefPubMed Sugino H, Watanabe A, Amada N, Yamamoto M, Ohgi Y, Kostic D, Sanchez R. Global trends in Alzheimer disease clinical development: increasing the probability of success. Clin Ther. 2015;37:1632–42.CrossRefPubMed
10.
go back to reference Andrieu S, Coley N, Lovestone S, Aisen PS, Vellas B. Prevention of sporadic Alzheimer’s disease: lessons learned from clinical trials and future directions. Lancet Neurol. 2015;14:926–44.CrossRefPubMed Andrieu S, Coley N, Lovestone S, Aisen PS, Vellas B. Prevention of sporadic Alzheimer’s disease: lessons learned from clinical trials and future directions. Lancet Neurol. 2015;14:926–44.CrossRefPubMed
11.
go back to reference Albert MS, DeKosky ST, Dickson D, Dubois B, Feldman HH, Fox NC, et al. The diagnosis of mild cognitive impairment due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011;7:270–9.CrossRefPubMedPubMedCentral Albert MS, DeKosky ST, Dickson D, Dubois B, Feldman HH, Fox NC, et al. The diagnosis of mild cognitive impairment due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 2011;7:270–9.CrossRefPubMedPubMedCentral
12.
go back to reference Dubois B, Feldman HH, Jacova C, Hampel H, Molinuevo JL, Blennow K, DeKosky ST, et al. Advancing research diagnostic criteria for Alzheimer’s disease: the IWG-2 criteria. Lancet Neurol. 2014;13:614–29. Erratum in: Lancet Neurol. 2014;13:757.CrossRefPubMed Dubois B, Feldman HH, Jacova C, Hampel H, Molinuevo JL, Blennow K, DeKosky ST, et al. Advancing research diagnostic criteria for Alzheimer’s disease: the IWG-2 criteria. Lancet Neurol. 2014;13:614–29. Erratum in: Lancet Neurol. 2014;13:757.CrossRefPubMed
15.
go back to reference Scheltens P, Blennow K, Breteler MM, de Strooper B, Frisoni GB, Salloway S, Van der Flier WM. Alzheimer’s disease. Lancet. 2016;388:505–17.CrossRefPubMed Scheltens P, Blennow K, Breteler MM, de Strooper B, Frisoni GB, Salloway S, Van der Flier WM. Alzheimer’s disease. Lancet. 2016;388:505–17.CrossRefPubMed
16.
go back to reference Hendrix JA, Bateman RJ, Brashear HR, Duggan C, Carrillo MC, Bain LJ, et al. Challenges, solutions, and recommendations for Alzheimer’s disease combination therapy. Alzheimers Dement. 2016;12:623–30.CrossRefPubMed Hendrix JA, Bateman RJ, Brashear HR, Duggan C, Carrillo MC, Bain LJ, et al. Challenges, solutions, and recommendations for Alzheimer’s disease combination therapy. Alzheimers Dement. 2016;12:623–30.CrossRefPubMed
21.
go back to reference Cumming J, Aisen P, Barton R, Bork J, Doody R, Dwyer J, et al. Re-engineering Alzheimer clinical trials: Global Alzheimer’s Platform network. J Prev Alz Dis. 2016;3:114–20. Cumming J, Aisen P, Barton R, Bork J, Doody R, Dwyer J, et al. Re-engineering Alzheimer clinical trials: Global Alzheimer’s Platform network. J Prev Alz Dis. 2016;3:114–20.
25.
go back to reference Gillette-Guyonneta S, Vellas B. The Toulouse Gérontopôle Research Center: report of activities, 2007–2011. J Alzheimers Dis. 2012;28:721–32. Gillette-Guyonneta S, Vellas B. The Toulouse Gérontopôle Research Center: report of activities, 2007–2011. J Alzheimers Dis. 2012;28:721–32.
26.
go back to reference van der Flier WM, Pijnenburg YA, Prins N, Lemstra AW, Bouwman FH, Teunissen CE, et al. Optimizing patient care and research: the Amsterdam Dementia Cohort. J Alzheimers Dis. 2014;41:313–27.PubMed van der Flier WM, Pijnenburg YA, Prins N, Lemstra AW, Bouwman FH, Teunissen CE, et al. Optimizing patient care and research: the Amsterdam Dementia Cohort. J Alzheimers Dis. 2014;41:313–27.PubMed
27.
go back to reference Kornhuber J, Schmidtke K, Frolich L, Perneczky R, Wolf S, Hampel H, et al. Early and differential diagnosis of dementia and mild cognitive impairment: design and cohort baseline characteristics of the German Dementia Competence Network. Dement Geriatr Cogn Disord. 2009;27:404–17.CrossRefPubMed Kornhuber J, Schmidtke K, Frolich L, Perneczky R, Wolf S, Hampel H, et al. Early and differential diagnosis of dementia and mild cognitive impairment: design and cohort baseline characteristics of the German Dementia Competence Network. Dement Geriatr Cogn Disord. 2009;27:404–17.CrossRefPubMed
28.
go back to reference Zahodne LB, Manly JJ, MacKay-Brandt A, Stern Y. Cognitive declines precede and predict functional declines in aging and Alzheimer’s disease. PLoS One. 2013;8:e73645.CrossRefPubMedPubMedCentral Zahodne LB, Manly JJ, MacKay-Brandt A, Stern Y. Cognitive declines precede and predict functional declines in aging and Alzheimer’s disease. PLoS One. 2013;8:e73645.CrossRefPubMedPubMedCentral
29.
go back to reference Liu-Seifert H, Siemers E, Sundell K, Price K, Han B, Selzler K, et al. Cognitive and functional decline and their relationship in patients with mild Alzheimer’s dementia. J Alz Dis. 2015;43:949–55. Liu-Seifert H, Siemers E, Sundell K, Price K, Han B, Selzler K, et al. Cognitive and functional decline and their relationship in patients with mild Alzheimer’s dementia. J Alz Dis. 2015;43:949–55.
30.
go back to reference Dubois B, Albert ML. Amnestic MCI or prodromal Alzheimer’s disease? Lancet Neurol. 2004;3:246–8.CrossRefPubMed Dubois B, Albert ML. Amnestic MCI or prodromal Alzheimer’s disease? Lancet Neurol. 2004;3:246–8.CrossRefPubMed
31.
go back to reference Sarazin M, Berr C, De Rotrou J, Fabrigoule C, Pasquier F, Legrain S, et al. Amnestic syndrome of the medial temporal type identifies prodromal AD: a longitudinal study. Neurology. 2007;69:1859–67.CrossRefPubMed Sarazin M, Berr C, De Rotrou J, Fabrigoule C, Pasquier F, Legrain S, et al. Amnestic syndrome of the medial temporal type identifies prodromal AD: a longitudinal study. Neurology. 2007;69:1859–67.CrossRefPubMed
32.
go back to reference Wagner M, Wolf S, Reischies FM, Daerr M, Wolfsgruber S, Jessen F, et al. Biomarker validation of a cued recall memory deficit in prodromal Alzheimer disease. Neurology. 2012;78:379–86.CrossRefPubMed Wagner M, Wolf S, Reischies FM, Daerr M, Wolfsgruber S, Jessen F, et al. Biomarker validation of a cued recall memory deficit in prodromal Alzheimer disease. Neurology. 2012;78:379–86.CrossRefPubMed
33.
go back to reference Jekel K, Damian M, Wattmo C, Hausner L, Bullock R, Connelly PJ, et al. Mild cognitive impairment and deficits in instrumental activities of daily living: a systematic review. Alzheimers Res Ther. 2015;18:7–17. Jekel K, Damian M, Wattmo C, Hausner L, Bullock R, Connelly PJ, et al. Mild cognitive impairment and deficits in instrumental activities of daily living: a systematic review. Alzheimers Res Ther. 2015;18:7–17.
35.
go back to reference Donohue MC, Sperling RA, Salmon DP, Rentz DM, Raman R, Thomas RG, et al. Australian Imaging, Biomarkers, and Lifestyle Flagship Study of Ageing, Alzheimer’s Disease Neuroimaging Initiative, Alzheimer’s Disease Cooperative Study. The preclinical Alzheimer cognitive composite: measuring amyloid-related decline. JAMA Neurol. 2014;71:961–70.CrossRefPubMedPubMedCentral Donohue MC, Sperling RA, Salmon DP, Rentz DM, Raman R, Thomas RG, et al. Australian Imaging, Biomarkers, and Lifestyle Flagship Study of Ageing, Alzheimer’s Disease Neuroimaging Initiative, Alzheimer’s Disease Cooperative Study. The preclinical Alzheimer cognitive composite: measuring amyloid-related decline. JAMA Neurol. 2014;71:961–70.CrossRefPubMedPubMedCentral
36.
go back to reference Wessels AM, Siemers ER, Yu P, Andersen SW, Holdridge KC, Sims JR, et al. A combined measure of cognition and function for clinical trials: the integrated Alzheimer’s disease rating scale. J Prev Alz Dis. 2015;2:227–41. Wessels AM, Siemers ER, Yu P, Andersen SW, Holdridge KC, Sims JR, et al. A combined measure of cognition and function for clinical trials: the integrated Alzheimer’s disease rating scale. J Prev Alz Dis. 2015;2:227–41.
37.
go back to reference Wang J, Logovinsky V, Hendrix SB, Stanworth SH, Perdomo C, Xu L, et al. ADCOMS: a composite clinical outcome for prodromal Alzheimer’s disease trials. J Neurol Neurosurg Psychiatry. 2016;87:993–9.CrossRefPubMedPubMedCentral Wang J, Logovinsky V, Hendrix SB, Stanworth SH, Perdomo C, Xu L, et al. ADCOMS: a composite clinical outcome for prodromal Alzheimer’s disease trials. J Neurol Neurosurg Psychiatry. 2016;87:993–9.CrossRefPubMedPubMedCentral
38.
go back to reference Olsson B, Lautner R, Andreasson U, Öhrfelt A, Portelius E, Bjerke M, et al. CSF and blood biomarkers for the diagnosis of Alzheimer’s disease: a systematic review and meta-analysis. Lancet Neurol. 2016;15:673–84.CrossRefPubMed Olsson B, Lautner R, Andreasson U, Öhrfelt A, Portelius E, Bjerke M, et al. CSF and blood biomarkers for the diagnosis of Alzheimer’s disease: a systematic review and meta-analysis. Lancet Neurol. 2016;15:673–84.CrossRefPubMed
39.
go back to reference Siemers ER, Sundell KL, Carlson C, Case M, Sethuraman G, Liu-Seifert H, et al. Phase 3 solanezumab trials: secondary outcomes in mild Alzheimer’s disease patients. Alzheimers Dement. 2016;12:110–20.CrossRefPubMed Siemers ER, Sundell KL, Carlson C, Case M, Sethuraman G, Liu-Seifert H, et al. Phase 3 solanezumab trials: secondary outcomes in mild Alzheimer’s disease patients. Alzheimers Dement. 2016;12:110–20.CrossRefPubMed
40.
go back to reference Petersen RC, Aisen P, Boeve BF, Geda YE, Ivnik RJ, Knopman DS, et al. Criteria for mild cognitive impairment due to alzheimer’s disease in the community. Ann Neurol. 2013;74:199–208.PubMedPubMedCentral Petersen RC, Aisen P, Boeve BF, Geda YE, Ivnik RJ, Knopman DS, et al. Criteria for mild cognitive impairment due to alzheimer’s disease in the community. Ann Neurol. 2013;74:199–208.PubMedPubMedCentral
41.
go back to reference Appleby BS, Nacopoulos D, Milano N, Zhong K, Cummings JL. A review: treatment of Alzheimer’s disease discovered in repurposed agents. Dement Geriatr Cogn Disord. 2013;35:1–22.CrossRefPubMed Appleby BS, Nacopoulos D, Milano N, Zhong K, Cummings JL. A review: treatment of Alzheimer’s disease discovered in repurposed agents. Dement Geriatr Cogn Disord. 2013;35:1–22.CrossRefPubMed
42.
go back to reference Appleby BS, Cummings JL. Discovering new treatments for Alzheimer’s disease by repurposing approved medications. Curr Top Med Chem. 2013;13:2306–27.CrossRefPubMed Appleby BS, Cummings JL. Discovering new treatments for Alzheimer’s disease by repurposing approved medications. Curr Top Med Chem. 2013;13:2306–27.CrossRefPubMed
43.
go back to reference Cummings JL, Zhong K, Kinney JW, Heaney C, Moll-Tudla J, Joshi A, et al. Double-blind, placebo-controlled, proof-of-concept trial of bexarotene in moderate Alzheimer’s disease. Alz Res Ther. 2016;8:4.CrossRef Cummings JL, Zhong K, Kinney JW, Heaney C, Moll-Tudla J, Joshi A, et al. Double-blind, placebo-controlled, proof-of-concept trial of bexarotene in moderate Alzheimer’s disease. Alz Res Ther. 2016;8:4.CrossRef
44.
go back to reference Sanchez PE, Zhu L, Verret L, Vossel KA, Orr AG, Cirrito JR, Devidze N, Ho K, Yu GQ, Palop JJ, Mucke L. Levetiracetam suppresses neuronal network dysfunction and reverses synaptic and cognitive deficits in an Alzheimer’s disease model. Proc Natl Acad Sci U S A. 2012;109:E2895–903.CrossRefPubMedPubMedCentral Sanchez PE, Zhu L, Verret L, Vossel KA, Orr AG, Cirrito JR, Devidze N, Ho K, Yu GQ, Palop JJ, Mucke L. Levetiracetam suppresses neuronal network dysfunction and reverses synaptic and cognitive deficits in an Alzheimer’s disease model. Proc Natl Acad Sci U S A. 2012;109:E2895–903.CrossRefPubMedPubMedCentral
45.
go back to reference Cummings JL, Zhong K. Repackaging FDA-approved drugs for degenerative diseases: promises and challenges. Expert Rev Clin Pharmacol. 2014;7:161–5.CrossRefPubMed Cummings JL, Zhong K. Repackaging FDA-approved drugs for degenerative diseases: promises and challenges. Expert Rev Clin Pharmacol. 2014;7:161–5.CrossRefPubMed
49.
go back to reference Shea M, Ostermann L, Hohman R, Roberts S, Kozak M, Dull R, et al. Impact of breakthrough therapy designation on cancer drug development. Nature. 2016;15:152. Shea M, Ostermann L, Hohman R, Roberts S, Kozak M, Dull R, et al. Impact of breakthrough therapy designation on cancer drug development. Nature. 2016;15:152.
51.
go back to reference Cummings JL, Morstorf T, Lee G. Alzheimer’s drug development pipeline: 2016. Alzheimers Dement. 2016 (in press). Cummings JL, Morstorf T, Lee G. Alzheimer’s drug development pipeline: 2016. Alzheimers Dement. 2016 (in press).
52.
go back to reference Liu Q, Waltz S, Woodruff G, Ouyang J, Israel MA, Herrera C, et al. Effect of potent-secretase modulator in human neurons derived from multiple presenilin 1-induced pluripotent stem cell mutant carriers. JAMA Neurol. 2014;71:1481–9.CrossRefPubMedPubMedCentral Liu Q, Waltz S, Woodruff G, Ouyang J, Israel MA, Herrera C, et al. Effect of potent-secretase modulator in human neurons derived from multiple presenilin 1-induced pluripotent stem cell mutant carriers. JAMA Neurol. 2014;71:1481–9.CrossRefPubMedPubMedCentral
53.
go back to reference Choi SH, Kim YH, Hebisch M, Sliwinski C, Lee S, D'Avanzo C, et al. A three-dimensional human neural cell culture model of Alzheimer’s disease. Nature. 2014;515:274–8.CrossRefPubMedPubMedCentral Choi SH, Kim YH, Hebisch M, Sliwinski C, Lee S, D'Avanzo C, et al. A three-dimensional human neural cell culture model of Alzheimer’s disease. Nature. 2014;515:274–8.CrossRefPubMedPubMedCentral
59.
go back to reference Romero K, Ito K, Rogers JA, Polhamus D, Qiu R, Stephenson D, et al. The future is now: model‐based clinical trial design for Alzheimer’s disease. Clin Pharmacol Ther. 2015;97:210–4.CrossRefPubMed Romero K, Ito K, Rogers JA, Polhamus D, Qiu R, Stephenson D, et al. The future is now: model‐based clinical trial design for Alzheimer’s disease. Clin Pharmacol Ther. 2015;97:210–4.CrossRefPubMed
62.
go back to reference Tariot PN, Ho C, Langlois C, Reiman EM, Lopera F, Langbaum JB, et al. The Alzheimer’s Prevention Initiative. Alzheimers Dement. 2014;10(4):247. Tariot PN, Ho C, Langlois C, Reiman EM, Lopera F, Langbaum JB, et al. The Alzheimer’s Prevention Initiative. Alzheimers Dement. 2014;10(4):247.
63.
go back to reference Toga AW, Foster I, Kesselman C, Madduri R, Chard K, Deutsch EW, et al. Big biomedical data as the key resource for discovery science. J Am Med Inform Assoc. 2015;22:1126–31.PubMed Toga AW, Foster I, Kesselman C, Madduri R, Chard K, Deutsch EW, et al. Big biomedical data as the key resource for discovery science. J Am Med Inform Assoc. 2015;22:1126–31.PubMed
64.
go back to reference Haas M, Stephenson D, Romero K, Gordon M, Zach N, Geerts H; Brain Health Modeling Initiative. Big data to smart data in AD: real-world examples of advanced modeling and simulation. Alzheimers Dement. 2016. [Epub ahead of print]. doi: 10.1016/j.jalz.2016.05.005. Haas M, Stephenson D, Romero K, Gordon M, Zach N, Geerts H; Brain Health Modeling Initiative. Big data to smart data in AD: real-world examples of advanced modeling and simulation. Alzheimers Dement. 2016. [Epub ahead of print]. doi: 10.​1016/​j.​jalz.​2016.​05.​005.
65.
go back to reference Geerts H, Dacks PA, Devanarayan V, Haas M, Khachaturian Z, Gordon MF, Maudsley S, Romero K, Stephenson D; Brain Health Modeling Initiative (BHMI). From big data to smart data in Alzheimer’s disease. The brain health modeling initiative to foster actionable knowledge. Alzheimers Dement. 2016. [Epub ahead of print]. doi: 10.1016/j.jalz.2016.04.008. Geerts H, Dacks PA, Devanarayan V, Haas M, Khachaturian Z, Gordon MF, Maudsley S, Romero K, Stephenson D; Brain Health Modeling Initiative (BHMI). From big data to smart data in Alzheimer’s disease. The brain health modeling initiative to foster actionable knowledge. Alzheimers Dement. 2016. [Epub ahead of print]. doi: 10.​1016/​j.​jalz.​2016.​04.​008.
Metadata
Title
Drug development in Alzheimer’s disease: the path to 2025
Authors
Jeffrey Cummings
Paul S. Aisen
Bruno DuBois
Lutz Frölich
Clifford R. Jack Jr
Roy W. Jones
John C. Morris
Joel Raskin
Sherie A. Dowsett
Philip Scheltens
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Alzheimer's Research & Therapy / Issue 1/2016
Electronic ISSN: 1758-9193
DOI
https://doi.org/10.1186/s13195-016-0207-9

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