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Alzheimer's Disease: Current Treatment Practices and Opportunities, 2010

This report presents the findings of a comprehensive survey of current clinical practices in the treatment of Alzheimer’s Disease. This was carried out following the participation of more than 220 physicians, practicing predominantly in the US. The purpose of this study was to establish current everyday drug treatment practices for Alzheimer’s Disease and how current drug classes, individually and in combination, are prescribed for mild, moderate and severe stages of the disease. As part of this survey, more than 200 physicians also reported on the principal challenges of treating this disease and these findings are presented, analysed and discussed in this report.

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See also:  Alzheimers Disease Biomarkers, 2009

The treatment of Alzheimer’s Disease remains an area of significant unmet need, with therapies based largely on two drug classes: the cholinesterase inhibitors and the NMDA receptor antagonists. These drugs target the symptoms of the disease, however there is considerable need for disease-modifying therapies. Other therapeutic agents are used to treat this disease, which have also been surveyed as part of this work. This survey investigated the use of these drug classes for the treatment of mild, moderate and severe Alzheimer’s Disease , as well as examining the use of drug combinations. While available drugs to treat Alzheimer’s Disease are limited, current practices in how they are used and combined in treating mild, moderate and severe disease, vary greatly. This survey has examined current treatment practices, which includes off-label use.

In a therapeutic field where treatments for Alzheimer’s Disease are very limited, physicians seek to extent their understanding in this area in an effort to better understand how current drugs and combinations can best be used to target mild, moderate and severe stages. Knowledge in these areas is also important to drug developers, who seek a better understanding of patient needs and outcomes as part of their own efforts to develop more effective therapies. The present survey was carried out to meet interest in these areas. This report presents an analysis of the survey findings and includes:

1. Clinics: comprehensive details of current treatments for Alzheimer’s Disease , provided by more than 220 clinics.
2. Markets and opportunities: in-depth information and analysis relevant to therapeutic markets and opportunities in the Alzheimer’s Disease field.
3. Physicians: of the participants, 92% practiced in the US, 2% practiced in Canada and 6% in other countries. Of these, 28% worked in a geriatric department, 20% practiced in a hospital general department, 15% worked in a general practice and 10% worked in a university research/clinical practice. Approximately 90% of the participants worked as Geriatricians and 5% were General Physicians.
4. Disease stages: estimates of the percentage (%) of Alzheimer’s Disease patients treated by study participants for mild, moderate or severe disease.
5. Mild Alzheimer’s Disease: estimates of the percentage (%) of mild Alzheimer’s Disease patients who are prescribed Cholinesterase Inhibitors (e.g. donepezil, Aricept; rivastigmine, Exelon; galantamine, Reminyl; NMDA Receptor Antagonist (e.g. memantine - Namenda, Axura, Ebixa; Nootropics (e.g. piracetam - Nootropil); and other drug classes.
6. Mild Alzheimer’s Disease: first choice and second choice drug combinations of two or more of the drug classes Cholinesterase Inhibitors; NMDA Receptor Antagonist; Nootropics; Colostrinin; Vitamins and other drugs for the treatment of mild disease.
7. Moderate Alzheimer’s Disease: estimates of the percentage (%) of moderate Alzheimer’s disease patients who are prescribed Cholinesterase Inhibitors (e.g. donepezil, Aricept; rivastigmine, Exelon; galantamine, Reminyl; NMDA Receptor Antagonist (e.g. memantine - Namenda, Axura, Ebixa; Nootropics (e.g. piracetam - Nootropil); and other drug classes.
8. Moderate Alzheimer’s Disease: first and second-choice drug combinations of two or more of the drug classes Cholinesterase Inhibitors; NMDA Receptor Antagonist; Nootropics; Colostrinin; Vitamins and other drugs for the treatment of moderate disease.
9. Severe Alzheimer’s Disease: estimates of the percentage (%) of severe Alzheimer’s Disease patients who are prescribed Cholinesterase Inhibitors (e.g. donepezil, Aricept; rivastigmine, Exelon; galantamine, Reminyl; NMDA Receptor Antagonist (e.g. memantine - Namenda, Axura, Ebixa; Nootropics (e.g. piracetam - Nootropil); and other drug classes.
10. Severe Alzheimer’s Disease: first and second-choice drug combinations of two or more of the drug classes Cholinesterase Inhibitors; NMDA Receptor Antagonist; Nootropics; Colostrinin; Vitamins and other drugs for the treatment of severe disease.
11. The principal challenges and issues encountered in the treatment of Alzheimer’s disease.

Background to Alzheimer’s disease

A prevalence study in 2005 estimated there were 24·3 million people suffering from dementia globally, with 4·6 million new cases added every year. In the absence of a cure, the study suggested dementia sufferers will double every 20 years to 81·1 million by 2040. Of those reported to be suffering from dementia, 60% were living in developing countries, a figure expected to rise to 70% by 2040. Rates of increase of dementia are not uniform, and between 2001 and 2040 were projected to increase by 100% in developed countries and by more than 300% in India, China, and their south Asian and western Pacific neighbours. More than 50% of these dementia cases are due to Alzheimer’s Disease.

Today, approximately five million Americans suffer from Alzheimer’s Disease, a figure expected to rise to 14 million by 2050 if a cure is not found. One in eight persons in the US over the age of 65 and nearly half of those over 85 have Alzheimer’s Disease. Direct and indirect costs of Alzheimer’s Disease and other dementias in the US amount to more than $148 billion annually. It is estimated that 10 million Americans are caring for a person with Alzheimer’s Disease or another dementia, one third of whom are over the age of 60. It is estimated the worldwide costs for dementia care are over $315 billion annually.

Table of Contents

Chapter 1 Background p.10

• 1. Alzheimer’s disease
• 1.1 Statistics and costs
• 1.2 Treatment
• 1.3 This report

Chapter 2 The Survey p.14

• 2.1 The survey
• 2.2 Survey questions

Chapter 3 Survey Participants p.18

• 3.1 Summary
• 3.2 Overview
• 3.3 Findings

Chapter 4 Alzheimer’s Disease Patients p.23

• 4.1 Summary
• 4.2 Overview
• 4.3 Findings

Chapter 5 Drug Classes Prescribed For Mild Alzheimer’s Disease p.28

• 5.2 Overview
• 5.3 Findings

Chapter 6 Drug Combinations used in Mild Alzheimer’s Disease p.35

• 6.1 Summary
• 6.2 Overview
• 6.3 Findings

Chapter 7 Drug Classes Prescribed for Moderate Alzheimer’s Disease p.41

• 7.1 Summary
• 7.2 Overview
• 7.3 Findings

Chapter 8 Drug Combinations used in Mild Alzheimer’s Disease p.48

• 8.1 Summary
• 8.2 Overview
• 8.3 Findings

Chapter 9 Drug Classes Prescribed for Severe Alzheimer’s Disease p.53

• 9.1 Summary
• 9.2 Overview
• 9.3 Findings

Chapter 10 Drug Combinations used in Severe Alzheimer’s Disease p.60

• 10.1 Summary
• 10.2 Overview
• 10.3 Findings

Chapter 11 Study Participants p.65

Chapter 12 Discussion p.72

• 12.1 Treatment practices
• 12.2 Challenges and issues
• 12.3 Opportunities

Appendix 1 pp.78-104

Figures

• Figure 3.1 Participant countries  
• Figure 3.2 Participant organisations
• Figure 3.4 Participant physicians
• Figure 4.1 Percentage of patients with mild Alzheimer’s disease
• Figure 4.2 Percentage of patients with moderate Alzheimer’s disease
• Figure 4.3 Percentage of patients with severe Alzheimer’s disease
• Figure 4.4 Mean Percentage of patients with mild, moderate or severe Alzheimer’s disease
• Figure 5.1 Percentage of mild Alzheimer’s disease patients prescribed a cholinesterase inhibitors
• Figure 5.2 Percentage of mild Alzheimer’s disease patients prescribed an NMDA receptor antagonist
• Figure 5.3 Percentage of mild Alzheimer’s disease patients prescribed a nootropic
• Figure 5.4 Percentage of mild Alzheimer’s disease patients prescribed other drugs
• Figure 5.5 Percentage of mild Alzheimer’s disease patients prescribed all drugs
• Figure 6.1 First choice drug combinations used in the treatment of mild Alzheimer’s disease
• Figure 6.2 Second choice drug combinations used in the treatment of mild Alzheimer’s disease
• Figure 7.1 Percentage of moderate Alzheimer’s disease patients prescribed a cholinesterase inhibitors
• Figure 7.2 Percentage of moderate Alzheimer’s disease patients prescribed an NMDA receptor antagonist.
• Figure 7.3 Percentage of moderate Alzheimer’s disease patients prescribed a nootropic.
• Figure 7.4 Percentage of moderate Alzheimer’s disease patients prescribed other drugs.
• Figure 7.5 Percentage of moderate Alzheimer’s disease patients prescribed all drugs
• Figure 8.1 First choice drug combinations used in the treatment of moderate Alzheimer’s disease
• Figure 8.2 Second choice drug combinations used in the treatment of mild Alzheimer’s disease
• Figure 9.1 Percentage of severe Alzheimer’s disease patients prescribed a cholinesterase inhibitors
• Figure 9.2 Percentage of severe Alzheimer’s disease patients prescribed an NMDA receptor antagonist.
• Figure 9.3 Percentage of severe Alzheimer’s disease patients prescribed a nootropic.
• Figure 9.4 Percentage of severe Alzheimer’s disease patients prescribed other drugs.
• Figure 9.5 Percentage of severe Alzheimer’s disease patients prescribed all drugs
• Figure 10.1 First choice drug combinations used in the treatment of severe Alzheimer’s disease
• Figure 10.2 Second choice drug combinations used in the treatment of severe Alzheimer’s disease
• Figure 12.1 Percentage of mild Alzheimer’s disease patients prescribed cholinesterase inhibitors
• Figure 12.4 Top-10 limitations and issues encountered in the treatment of Alzheimer’s disease

Tables

• Table 3.1 Participant organisations
• Table 5.1 Other treatments used for patients with mild Alzheimer’s disease
• Table 6.1 First choice drug combinations used in the treatment of mild Alzheimer’s disease
• Table 6.2 Second choice drug combinations used in the treatment of mild Alzheimer’s disease
• Table 7.1 Other treatments used for patients with moderate Alzheimer’s disease
• Table 8.1 First choice drug combinations used in the treatment of moderate Alzheimer’s disease
• Table 8.2 Second choice drug combinations used in the treatment of moderate Alzheimer’s disease
• Table 9.1 Other treatments used for patients with moderate Alzheimer’s disease
• Table 10.1 First choice drug combinations used in the treatment of severe Alzheimer’s disease
• Table 10.3 Second choice drug combinations used in the treatment of severe Alzheimer’s disease
• Table 11.1 Study Participants
• Table 12.1 The percentage of mild, moderate and severe AD patients who are prescribed cholinesterase inhibitors,
• MDA receptor antagonists, nootropics and other drugs
• Table 12.2 The percentage of physicians prescribing cholinesterase inhibitors and NMDA receptor antagonists to 50% or less of their mild, moderate or severe Alzheimer’s disease patients. 
• Table 12.3 First and second choice prescribing patterns for mild, moderate or severe Alzheimer’s disease using either cholinesterase inhibitors of NMDA receptor antagonists, independently of other drugs. 
• Table 12.4 Limitations and issues encountered in the treatment of Alzheimer’s disease

Appendix 1. Responses provided by study participants to the question: What are the major issues and challenges associated with the treatment of Alzheimer’s disease? Responses given by physicians to this question (which in some cases may be brief, informal or abbreviated) are presented verbatim, except in those some cases where minor grammatical or typographical corrections have been made for reasons of clarity.

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