August 14, 2019

Where Are We in the Search for Better Treatments? Dr. Scott Turner, Georgetown University

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The search for an effective Alzheimer’s treatment has seen many disappointments in recent years. However, a new report indicates that the pipeline of drugs in development is far from empty.

The 2019 state-of-the-pipeline report, from our ResearchersAgainstAlzheimer’s network, gives cause for optimism. Researchers are studying a broader range of ideas, including three new pathways to fight Alzheimer’s that have emerged in just the past year. Potential drugs that target amyloid in the brain have increased 30% since 2017, and the first wave of Alzheimer's prevention trials is well underway.

In this Alzheimer’s Talk, host Meryl Comer spoke with one of the nation’s leading Alzheimer’s researchers, Dr. Scott Turner, director of the Georgetown University Memory Disorders Program and a professor of neurology at Georgetown.

Press 'Play' button under the image at left to hear the full session.

The ResearchersAgainstAlzheimer’s pipeline report identifies, classifies and inventories drugs currently in the Phase II and Phase III studies required before a potential drug is submitted for FDA review. Phase II studies of drugs targeting amyloid have increased 30% since 2017, but that number has dropped nearly 50% in Phase III studies, due to a low success rate.

“We’ve had a lot of setbacks lately, particularly with anti-amyloid strategies. The whole field is having a rethink of the amyloid hypothesis,” Dr. Turner said.

While drug research targeting amyloid continues, he believes we must explore a broader range of strategies, including inflammation in the Alzheimer’s brain, antivirals, and endocrine treatments, as well as plaques and tangles. “I think we need to try many, many things in parallel,” he said.

“It’s possible we may need a combination treatment strategy,” Dr. Turner said, comparing Alzheimer’s research to HIV, which saw breakthroughs when drugs were combined, making HIV a manageable chronic disorder.

Like patients and families, researchers and health care professionals feel the urgency of fighting Alzheimer’s as its impact grows each year. Staying motivated in the face of unsuccessful studies is hard, but Dr. Turner recognizes the toll it takes on patients and families, especially those who are study participants. He says continued enthusiasm is needed from all quarters—as is more research funding: “Funding is still really inadequate to the size of the problem and the cost. We should have 10 times the number of Phase II and Phase III studies that we currently have.”

Beyond treatment studies, research is making strides to help us diagnose Alzheimer’s accurately at an earlier stage, such as through biomarker blood tests and better amyloid or tau PET scans—although these are not yet FDA approved. An Alzheimer’s prevention trial is also under way that’s studying an anti-amyloid antibody given to cognitively normal adults who have a positive amyloid PET scan. The hope is that it may slow or stop the progression of cognitive decline.

At his clinic, Dr. Turner sees patients with or at risk of memory problems, screening them for things that may be treatable or reversible, such as depression, medications or obstructive sleep apnea. “Our first task is to make a very specific diagnosis to try to target the right treatments,” he said.

He recommends that anyone concerned about memory issues see their primary doctor for initial screening and evaluation. The common reluctance to seek an evaluation and diagnosis for memory issues may stem from a belief that nothing can be done. Dr. Turner disagrees. “There are treatments that are available now. There are four FDA-approved drugs for Alzheimer’s that have some benefits.”

Dr. Turner is often asked how to avoid his clinic. He advises getting enough sleep, eating well, not smoking, avoiding head injuries, exercising, and keeping a healthy body weight. Addressing these could lead to five to 10 more healthy years by delaying Alzheimer’s onset. And it’s never too late to start reducing your risk. He described the top risk factors for dementia and Alzheimer’s as aging, genetics and family history, followed probably he says by diabetes, obesity and metabolic syndrome, particularly in midlife.

In closing, Dr. Turner noted the urgent need for those with or at risk for Alzheimer’s to volunteer for research. Alzheimer’s studies across the country are recruiting, but their progress is slow from a lack of volunteers. Another issue is recruiting enough minority participants, particularly since Hispanics and African Americans are at higher risk. He said most studies have 10% to 15% minority participation, but 20% or more would be better. “If a new treatment comes out, we don’t want to know if it only works for Caucasians. We want to know if it works for everyone and what are the differences between [races].”

To find an Alzheimer’s research study near you, visit clinicaltrials.gov. Hundreds of studies are looking for volunteers, and participation by research volunteers is the only way we will get to a cure.