In the decades Prof. Paul Maruff has been active in the neuroscience world, he has contributed to and collaborated on a vast library of clinical research dedicated to finding a treatment to Alzheimer’s disease (AD). So, when we asked him to reflect on what he heard at the 2023 AAIC meeting in Amsterdam, Netherlands, his overwhelming message was one of excitement and optimism on the current state of AD treatment options that will soon be available to help the people, families, and communities impacted by this disease.
We invite you to read his thoughts and share in the momentum!
Paul Maruff, PhD (Co-founder and Chief Innovation Officer, Cogstate)
It’s been 20 years in the wilderness since the approval of Donepezil, the last cholinesterase inhibitor. Since then, we’ve been working like crazy to find answers and get new drugs approved.
With so many failed trials, there was much consideration and thought on the causes of those failures. Was it the disease? Was it the endpoints? Was it the clinical trial design? Was it the method of patient recruitment? Was it statistical analyses?
All those things got raked over in detail by research teams worldwide, and Cogstate has been right in the middle of that reanalysis and reconsideration, aiming to support and help however we could.
Gradually, over the last decade, the answer started to become clear that the difficulty we were having was understanding the biology of the disease. We started to focus on amyloid, rather than acetylcholine, as a mechanism of action and what its presence meant for people.
Amyloid Hypothesis Yields Fruit
Now what you’ll see in the approval of lecanemab and, the likely approval of donanemab, is a very sophisticated change in the way we understand Alzheimer’s biology, which is this amyloid centric view. Specifically, the way in which we can detect it, its relationship to the symptomatic expression of the disease and—the most astounding aspect—the absolute refinement of finding out if by the removal of amyloid, we could have some effect on the clinical symptoms.
The answer to that is now a resounding yes. This means that we live in a different world today.
The lecanemab results were incredible, as were the donanemab results that confirmed the first results were not a fluke, that this is a real mechanism to reduce symptomatic expression of the disease.
Also, the donanemab results showed that by understanding the biology of the disease, we can reduce amyloid and tau together, so these processes are not independent but related as part of a cascade effect. Truly incredible findings!
As I was watching the donanemab presentation, I couldn’t have been prouder of my colleagues at Cogstate and our involvement in the efforts that led to this major breakthrough in medical science.
I have a saying that, “a life in science is a life of disappointment, interspersed by brief periods of relief.” AAIC was a time of relief and celebration. As I was walking around the AAIC conference this year, I couldn’t help but smile and say to people, “Stop. Do you realize what’s just happened? This is an incredible day!”
Research that will Change the World
For me, after 20 years in this search for AD improvements, I cannot begin to express my excitement. This new information will only improve the science going forward. The drugs will be better. The clinical expression will be larger. The people who receive these treatments will be more targeted and the safety will increase. And the speed of progress will really pick-up.
Overall, the 2023 AAIC meeting was the most amazing I have ever been to. I’m eager to support what comes next to help the many people, families, and communities impacted by AD.
