Dr. Derek Lowe, from In the Pipeline, writes about another disappointing failure to treat Alzheimer's Disease:
Merck announced last night that the first Phase III trial of their beta-secretase (BACE) inhibitor verubecestat was stopped because of futility. The monitoring committee, after looking over the data so far (the trial's been running since 2012) concluded that there was no real chance of seeing efficacy.
[...] The list of Alzheimer's clinical failures is impressive, but the list of failures to clinically validate the amyloid hypothesis is even more so.
[...] Beta-secretase inhibitors have failed in the clinic. Gamma-secretase inhibitors have failed in the clinic. Anti-amyloid antibodies have failed in the clinic. Everything has failed in the clinic. You can make excuses and find reasons – wrong patients, wrong compound, wrong pharmacokinetics, wrong dose, but after a while, you wonder if perhaps there might not be something a bit off with our understanding of the disease. Remember, every time one of these therapies comes around, it builds on the failures before it. Better and better attempts are made – I mean, verubecestat seems to be a pretty good compound, from the preclinical drug discovery perspective. It's surely the best swing anyone's taken at beta-secretase (and there have been many). But it just flat out did not work.
The good news about this study is that it adds to the evidence that the amyloid hypothesis of Alzheimer's Disease is a blind alley and that the presence of amyloid plaques is simply correlative and not causative. As more data comes in from the study, I hope that the evidence will be conclusive enough that more effort will be spent on pursuing other therapeutic targets.
See also: https://en.wikipedia.org/wiki/Alzheimer's_disease#Amyloid_hypothesis
Related Stories
Dr. Lowe, from In the Pipeline, writes of how the efficacy requirements of the FDA save US taxpayers money:
Remember solanezumab? That was the amyloid-targeting antibody that Eli Lilly kept on investigating in trial after trial, looking for some effect on Alzheimer’s. Last November, the final, final word finally came down that it really, truly, does not work. To recap, mouse model results with a similar antibody were published in 2001. Phase I results of solanezumab itself were published in 2010, and Phase II results were published in 2012.
The authors of the NEJM [New England Journal of Medicine] paper would like to point out that under the current system, the cost of investigating all this was largely borne by the drug’s developers, not the patients and not the taxpayers
[...] Under a system designed to speed up drug approvals, people might have started taking it back in 2010-2012, when the Phase I and II results showed no adverse effects.
[...] We have a very tightly regulated and opaque market indeed in this country for prescription drugs and every other form of health care, and it’s not a very good place to discover prices or utilities. You could imagine a system where these things could be done better than we’re doing them, but such a system would be pretty far from what we have going now.
[...] The NEJM paper estimates, pretty conservatively, that had solanezumab been given conditional approval back in 2012 or so, that we – meaning Medicare, for the most part, which is to say all taxpayers, but also insurance companies and patients – would have spent at least ten billion dollars injecting Alzheimer’s patients with an expensive placebo. No one would have gotten the tiniest bit better. False hope all around, with no benefit, and billions of dollars down the tubes.
Note: Bold added by submitter.
http://blogs.sciencemag.org/pipeline/archives/2017/05/09/there-are-failures-you-know
http://www.nejm.org/doi/full/10.1056/NEJMp1701047
https://en.wikipedia.org/wiki/Solanezumab
https://en.wikipedia.org/wiki/Alzheimer%27s_disease
https://soylentnews.org/article.pl?sid=16/11/27/0147228
https://soylentnews.org/article.pl?sid=17/02/16/0116248
Pfizer has announced that it will halt efforts to find new treatments for Alzheimer's and Parkinson's diseases. Meanwhile, Axovant Sciences will halt its studies of intepirdine after it failed to show any improvement for dementia and Alzheimer's patients. The company's stock price has declined around 90% in 3 months:
Pfizer has announced plans to end its research efforts to discover new drugs for Alzheimer's and Parkinson's diseases. The pharmaceutical giant explained its decision, which will entail roughly 300 layoffs, as a move to better position itself "to bring new therapies to patients who need them."
"As a result of a recent comprehensive review, we have made the decision to end our neuroscience discovery and early development efforts and re-allocate [spending] to those areas where we have strong scientific leadership and that will allow us to provide the greatest impact for patients," Pfizer said in a statement emailed to NPR.
[...] Despite heavily funding research efforts into potential treatments in the past, Pfizer has faced high-profile disappointment in recent years, as Reuters notes: "In 2012, Pfizer and partner Johnson & Johnson (JNJ.N) called off additional work on the drug bapineuzumab after it failed to help patients with mild to moderate Alzheimer's in its second round of clinical trials."
Another potential treatment for neurodegenerative disorders — this one developed by Axovant, another pharmaceutical company — also found itself recently abandoned. The company dropped its experimental drug intepirdine after it failed to improve motor function in patients with a certain form of dementia — just three months after it also failed to show positive effects in Alzheimer's patients.
Looks like GlaxoSmithKline got a good deal when they sold the rights to intepirdine to Axovant Sciences in 2014.
Also at Bloomberg.
Related: Can we Turn Back the Clock on Alzheimer's?
Possible Cure for Alzheimer's to be Tested Within the Next Three Years
Mefenamic Acid Might Cure Alzheimers - Generic Cost in US is Crazy
New Alzheimer's Treatment Fully Restores Memory Function in Mice
Power Outage in the Brain may be Source of Alzheimer's
Another Failed Alzheimer's Disease Therapy
The FDA Saved Taxpayers from Paying Billions for Ineffective Alzheimer's Therapy
Alzheimer's Disease: A "Whole Body" Problem?
Bill Gates Commits $100 Million to Alzheimer's Research
Evidence That Alzheimer's Protein Spreads Like an Infection
https://blogs.sciencemag.org/pipeline/archives/2020/01/27/coronavirus
As the world knows, we face an emerging virus threat in the Wuhan coronavirus (2019-nCoV) outbreak. The problem is, right now there are several important things that we don't know about the situation. The mortality rate, the ease of human-human transmission, the rate of mutation of the virus (and how many strains we might be dealing with – all of these need more clarity. Unfortunately, we've already gone past the MERS outbreak in severity (which until now was the most recent new coronavirus to make the jump into humans). If we're fortunate, though, we'll still have something that will be worrisome, but not as bad as (say) the usual flu numbers (many people don't realize that influenza kills tens of thousands of people in the US each year). The worst case, though, is something like 1918, and we really, really don't need that.
[Ed note: The linked story is by Derek Lowe who writes a "commentary on drug discovery and the pharma industry". He is perhaps best known for his "Things I Won't Work With" blog entries which are as hilarious as they are... eye opening. I have found him to be a no-nonsense writer who "tells things as they are", holding no punches. The whole story is worth reading as he clearly explains what a coronavirus is, about the current one that reportedly originated in Wuhan, China, what could be done about it, how long that would likely take, and what can be done for those who have already been infected. --martyb]
Previous Stories Referencing Derek Lowe:
Machine Learning Comes to Biochemistry
Ignition! The Funniest, Most Accessible Book on Rocket Science is Being Reissued
Another Failed Alzheimer's Disease Therapy
Marathon Pharmaceuticals is Part of the Problem
Lobbying Results in FDA Approval for Controversial Drug
"Right to Try" New Experimental Medicine and the Value of Experts
Cancer Hazard vs. Risk - Glyphosate
A Terrific Paper on the Problems of Drug Discovery
Things I Won't Work With
(Score: 3, Informative) by opinionated_science on Thursday February 16 2017, @12:05PM
It has been shown that the amyloids are responsible - we don't know if they are the *only* factor.
One proof is really quite simple - give the amyloid gene of different lengths (up to 42) to mice, and they develop symptoms in 10 months which mice normally don't (10 months is ancient for a mouse).
Trisomy 21(Downs) carriers in humans get Alzheimers very quickly (before 40), as the ABgene is on chr 21 a bad dosage gets amplified.
The length of the ABeta product matters - aggregation of the fibrils into plaques occurs more aggressively, and is harder to break up.
There are many compounds we can get to break up ABeta. There are fewer we can get into the body. There are a few (like this) that looked to down regulate AB production.
There is a strong correlation between diabetes and Alzheimers - yet another reason to stay slimmer than is easy...
There are no compounds we know that currently work sufficiently to arrest the conditions.
Drug Design is Hard (TM).
(Score: 0) by Anonymous Coward on Thursday February 16 2017, @02:22PM
Both the drug mentioned in TFA and the anti-amyloid antibodies from Lilly reduced amyloid in patient CSF (we'll have to wait to see their brains) and they had great results in animal models. If these therapies reduce amyloids, but do not affect disease in any measurable way (despite Lilly running many PIII trials) then at what point do you stop trying to reduce amyloids (at least directly)?
The animal models were specifically designed to have an amyloid-driven disease and trisomy is not really great genetic evidence. There is better amyloid hypothesis-supporting genetic evidence in some early onset patients but there are also the ApoE4 carrying Nigerians that complicate things by not having the expected phenotype.
Targeting amyloids seem to be a blind therapeutic alley. Amyloids may still be bad or they may be a biomarker for something bad, but the therapeutic targets that need to be pursued are probably upstream amyloid production or downstream (caspase activation or the immune system).
(Score: 0) by Anonymous Coward on Thursday February 16 2017, @12:05PM
Too bad biomed programs are driving away all the competent people with their pointless and endless statistical significance hunts. The more money you give them, the more BS they will produce. Amyloids are the most thermodynamically stable state of peptides in general, it is so obvious this idea has cause and effect reversed.
(Score: 0) by Anonymous Coward on Thursday February 16 2017, @02:31PM
If everything is so fucking obvious to you, then why don't you cure Alzheimer's?
There is plenty of evidence that plaque formation can be pathological. Prion diseases such as Mad Cow, CJD, and CWD show very direct evidence of transmissible disease.
Alzheimer's is complicated and there doesn't seem to be anything that is obvious about the causal mechanisms.
(Score: 0) by Anonymous Coward on Thursday February 16 2017, @02:38PM
First, knowing something is the wrong approach doesn't mean you know the right approach. You can just tell when people are wasting time/money. Second, I can't stand the culture of the biomedical community. Really, I was so angry and depressed all the time when I had to work with those people.
(Score: 0) by Anonymous Coward on Thursday February 16 2017, @03:33PM
knowing something is the wrong approach
You apparently know the amyloid hypothesis is wrong because it is obvious to you. How is all the genetic evidence so obviously wrong?
I've been skeptical of the amyloid hypothesis for a while and new evidence keeps adding doubt to it being a complete explanation of the causal mechanism of disease, but it is certainly not obvious that it is entirely wrong.
(Score: 0) by Anonymous Coward on Thursday February 16 2017, @04:03PM
As mentioned, all peptides can form amyloids, they are a generic structure. Beta-sheet aggregates are the lowest energy state for peptides, so there is no mystery they start forming when things get messed up.
(Score: 0) by Anonymous Coward on Thursday February 16 2017, @04:56PM
Prions also form amyloids and their formation directly induces disease. How is it obvious that the amyloids in Alzheimer's are benign?
Populations with genetic determinants that specifically predispose them to producing amyloid beta in the brain develop early onset Alzheimer's at a much higher rate than non-carriers. How is it obvious that all these cases are simply a coincidence?
Populations with genetic determinants that predispose them to have inefficient clearance of amyloid beta in the brain have increased Alzheimer's risk than non-carriers. How is it obvious that these cases are a coincidence?
(Score: 0) by Anonymous Coward on Friday February 17 2017, @08:27AM
Would you mind jotting down the answer in the margin so we may study your works in the future?
(Score: 1, Funny) by Anonymous Coward on Friday February 17 2017, @01:31AM
The obvious rebuttal is that the FDA is holding these companies back.
If they didn't have to actually prove that these drugs work, the drugs would already be on the market.
I demand we let the free market decide!! That's the only sane way to operate anyway.