What reason do you have to think your stroke hospital knows about this AND knows you need it? A call to the president and board of directors will be required.
Your chances of getting dementia.
1. A documented 33% dementia chance post-stroke from an Australian study? May 2012.
2. Then this study came out and seems to have a range from 17-66%. December 2013.
3. A 20% chance in this research. July 2013.
4. Dementia Risk Doubled in Patients Following Stroke September 2018
5. Parkinson’s Disease May Have Link to Stroke March 2017
Clinicians view new Alzheimer’s drug with guarded optimism
This year, Biogen is
expected to submit a Biologics License Application to the FDA for its
anti-amyloid antibody, aducanumab. If approved, it will be the first new
drug available to patients with Alzheimer’s disease in 16 years.
Administered intravenously once a month, aducanumab clears some of the plaque materials that may cause cell death and tissue loss in the brain caused by Alzheimer's disease, according to Barry Reisberg, MD, one of the clinical investigators who developed the Alzheimer’s drug memantine, which was approved back in 2003.
Although it is not curative, aducanumab could be a valuable addition to the clinician’s armamentarium, according to Sharon A. Brangman, MD,
chair of the geriatrics department and director of the Center for
Excellence for Alzheimer’s Disease at Upstate Medical University in New
York.
“Aducanumab is exciting in terms of adding more information to our knowledge of Alzheimer’s disease and maybe offering potential treatment, but it is not a cure,” she said.
The Alzheimer’s Association estimates that 5.8 million Americans live
with Alzheimer’s, and the disease cost the country about $290 billion
in 2019. Healio Primary Care discussed aducanumab with several experts
to see where the drug fits in the treatment landscape and what its
approval could mean for patients.
What is aducanumab?
The mechanism behind aducanumab, an anti-amyloid antibody, is different than donepezil, rivastigmine, memantine and galantamine — which are cholinesterase inhibitors or glutamate modulators and the three currently approved medications to treat patients with Alzheimer’s dementia.
Researchers have previously reported that aducanumab is a human monoclonal antibody that selectively binds to amyloid fibrils and soluble oligomers. Donepezil is a centrally acting, reversible, rapid inhibitor of acetyl cholinesteras that binds reversibly to acetylcholinesterase and impedes the hydrolysis of acetylcholine. Memantine is an antagonist of the N-Methyl-D-Aspartate subtype of glutamate receptors in the central nervous system, while donepezil. rivastigmine and galantamine are cholinesterase inhibitors and reversibly inhibit acetylcholine esterase and improve the intrinsic action of acetylcholine on cholinergic receptors.
According to Biogen, aducanumab was evaluated in two, phase 3 randomized controlled trials — EMERGE (n = 1,638) and ENGAGE (n = 1,647). Although the EMERGE trial met its primary endpoint showing a significant reduction in clinical decline, the trials were discontinued in March 2019 following the results of a futility analysis, which the company said “relied on an earlier and smaller data set.”
Biogen then conducted an additional analysis with a larger data set that yielded positive results.
“They found that there was a subgroup of patients who had mild cognitive impairment but did not meet the criteria for Alzheimer’s disease or any dementia who got higher doses, [and those patients] did have improvement in their cognition,” Brangman said. “Then, when Biogen did a PET scan, these patients did not have amyloid buildup. So, the thinking is that if you remove this amyloid, you may be treating their Alzheimer’s disease.”
The price of aducanumab could be a factor in whether or not patients request or adhere to the medication.
The authors of a recent Neurology study found that a $50 increase in out-of-pocket costs was associated with a 12-percent decrease in the time that a person had access to medication. For example, in 2015, when the cost of the drug donepezil was about $3 for a 30-day supply, patients filled those prescriptions about 70% of the time. Patients prescribed rivastigmine, which cost about $100 for a 30-day supply in 2015, filled their prescriptions about 45 percent of the time.
Biogen declined to answer questions about the price of the drug for this story.
Administered intravenously once a month, aducanumab clears some of the plaque materials that may cause cell death and tissue loss in the brain caused by Alzheimer's disease, according to Barry Reisberg, MD, one of the clinical investigators who developed the Alzheimer’s drug memantine, which was approved back in 2003.
“Aducanumab is exciting in terms of adding more information to our knowledge of Alzheimer’s disease and maybe offering potential treatment, but it is not a cure,” she said.
What is aducanumab?
The mechanism behind aducanumab, an anti-amyloid antibody, is different than donepezil, rivastigmine, memantine and galantamine — which are cholinesterase inhibitors or glutamate modulators and the three currently approved medications to treat patients with Alzheimer’s dementia.
Researchers have previously reported that aducanumab is a human monoclonal antibody that selectively binds to amyloid fibrils and soluble oligomers. Donepezil is a centrally acting, reversible, rapid inhibitor of acetyl cholinesteras that binds reversibly to acetylcholinesterase and impedes the hydrolysis of acetylcholine. Memantine is an antagonist of the N-Methyl-D-Aspartate subtype of glutamate receptors in the central nervous system, while donepezil. rivastigmine and galantamine are cholinesterase inhibitors and reversibly inhibit acetylcholine esterase and improve the intrinsic action of acetylcholine on cholinergic receptors.
According to Biogen, aducanumab was evaluated in two, phase 3 randomized controlled trials — EMERGE (n = 1,638) and ENGAGE (n = 1,647). Although the EMERGE trial met its primary endpoint showing a significant reduction in clinical decline, the trials were discontinued in March 2019 following the results of a futility analysis, which the company said “relied on an earlier and smaller data set.”
Biogen then conducted an additional analysis with a larger data set that yielded positive results.
“They found that there was a subgroup of patients who had mild cognitive impairment but did not meet the criteria for Alzheimer’s disease or any dementia who got higher doses, [and those patients] did have improvement in their cognition,” Brangman said. “Then, when Biogen did a PET scan, these patients did not have amyloid buildup. So, the thinking is that if you remove this amyloid, you may be treating their Alzheimer’s disease.”
The price of aducanumab could be a factor in whether or not patients request or adhere to the medication.
The authors of a recent Neurology study found that a $50 increase in out-of-pocket costs was associated with a 12-percent decrease in the time that a person had access to medication. For example, in 2015, when the cost of the drug donepezil was about $3 for a 30-day supply, patients filled those prescriptions about 70% of the time. Patients prescribed rivastigmine, which cost about $100 for a 30-day supply in 2015, filled their prescriptions about 45 percent of the time.
Biogen declined to answer questions about the price of the drug for this story.
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