Here's what I got from it:
- Both doctors are cautiously optimistic about the amyloid approach and don't believe it should be discarded, but at the same time acknowledge that clearing amyloid isn't correlated with improving cognition, and that it will most likely be used to stop the damaging effects of too much amyloid in the brain rather than cure the disease.
- They both believe that better trial designs and ways of measuring patients are needed.
- Dr. Farlow stressed the importance of designing trials to show significant/definitive results, and that interim analyses are good if they contribute to more significant/definitive results.
- IMO both the doctors and the market in general still seems to have a lot of faith in the amyloid theory, even though they acknowledge that past trials have either failed or shown very modest effects.
- Dr. Sabbagh believes that Aducanumab is the best "shot on goal", and Dr. Farlow says he "tends to agree". Both are cautiously optimistic but agree that it could fail like other trials.
- When asked about what would happen if the same drug failed in one trial but succeeded in the other, they say it would most likely head to registration due to the huge unmet demand for new AD drugs.
- Dr. Sabbagh seems encouraged by BAN2401, thinks that it got beat up because of its trial design and that the combination of cognitive stabilization and amyloid removal is encouraging.
- Both seem to agree that Tau has a better correlation to disease progression than amyloid, and seem cautiously optimistic about this field too.
Note that I may be misinterpreting their words considering how vague and cautious they are about their choice of words.
- When asked about BACE inhibitors they seem more pessimistic. Dr. Farlow adds a comment about how going after metabolism is a lot like hitting things with a hammer. He seems to see this method as a very crude way of going after the disease with lots of questionable effects.
- Some talk about combination therapies. both doctors acknowledge the possibility that Alzheimer's might have to be treated with multiple drugs rather than just one.
- Both doctors agree that peripheral biomarkers could be very important for diagnosing patients properly
- When asked about alternative approaches, Dr. Farlow says we're reaching the limits on cholinesterase inhibitors and NMDA inhibitors like Memantine. Very short, straight to the point, and pessimistic tone.
- Both doctors seem very encouraged by Bryostatin-1, and acknowledge its possibly synaptogenic effects from the 20 dose, and how the difference between groups becomes more clear when you remove Memantine out of the equation.
- They both seem to agree its an extremely promising and exciting drug due to its significant effect on a limited number of patients, but Dr. Farlow thinks that 15 weeks is too short, and that the amount of patients in the last trial was too small to show anything definitive. Says that if the confirmatory trial works out that this drug has lots of potential in other indications too. Both seem very optimistic about this.
- Some talk about going after inflammation, although they generally seem to agree it could be more of a downstream effect rather than a potential target for treating the disease.
- Some worries about the Aducanumab trial having its sample size changed in hopes of showing better results. Could be a sign that they don't have enough power/statistical significance and are trying to give it an extra chance by adding more patients.
AI
