J Cummings1, N Fox2. 1. Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA. 2. Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, United Kingdom.
Abstract
BACKGROUND: Disease-modifying therapies (DMTs) are urgently needed to treat the growing number of individuals with Alzheimer's disease (AD) or at immanent risk for AD. A definition of DMT is required to facilitate the process of DMT drug development. PROCESS: This is a review of the state of the science with regard to definition and development of DMTs. RESULTS: A DMT is as an intervention that produces an enduring change in the clinical progression of AD by interfering in the underlying pathophysiological mechanisms of the disease process that lead to cell death. Demonstration of DMT efficacy is garnered through clinical trial designs and biomarkers. Evidence of disease modification in the drug development process is based on trial designs such as staggered start and delayed withdrawal showing an enduring effect on disease course or on combined clinical outcomes and correlated biomarker evidence of an effect on the underlying pathophysiological processes of the disease. Analytic approaches such as showing change in slope of cognitive decline, increasing drug-placebo difference over time, and delay of disease milestones are not conclusive by themselves but support the presence of a disease modifying effect. Neuroprotection is a related concept whose demonstration depends on substantiating disease modification. No single type of evidence in itself is sufficient to prove disease modification - consistency, robustness, and variety of sources of data will all contribute to convincing stakeholders that an agent is a DMT. CONCLUSION: DMT is defined by its enduring effect on processes leading to cell death. A variety of types of data can be used to support the hypothesis that disease modification has occurred.
BACKGROUND: Disease-modifying therapies (DMTs) are urgently needed to treat the growing number of individuals with Alzheimer's disease (AD) or at immanent risk for AD. A definition of DMT is required to facilitate the process of DMT drug development. PROCESS: This is a review of the state of the science with regard to definition and development of DMTs. RESULTS: A DMT is as an intervention that produces an enduring change in the clinical progression of AD by interfering in the underlying pathophysiological mechanisms of the disease process that lead to cell death. Demonstration of DMT efficacy is garnered through clinical trial designs and biomarkers. Evidence of disease modification in the drug development process is based on trial designs such as staggered start and delayed withdrawal showing an enduring effect on disease course or on combined clinical outcomes and correlated biomarker evidence of an effect on the underlying pathophysiological processes of the disease. Analytic approaches such as showing change in slope of cognitive decline, increasing drug-placebo difference over time, and delay of disease milestones are not conclusive by themselves but support the presence of a disease modifying effect. Neuroprotection is a related concept whose demonstration depends on substantiating disease modification. No single type of evidence in itself is sufficient to prove disease modification - consistency, robustness, and variety of sources of data will all contribute to convincing stakeholders that an agent is a DMT. CONCLUSION: DMT is defined by its enduring effect on processes leading to cell death. A variety of types of data can be used to support the hypothesis that disease modification has occurred.
Authors: Michael S Mega; Ivo D Dinov; Verna Porter; George Chow; Erin Reback; Paras Davoodi; Susan M O'Connor; Michele F Carter; Herminia Amezcua; Jeffrey L Cummings Journal: Arch Neurol Date: 2005-05
Authors: Bruno Dubois; Howard H Feldman; Claudia Jacova; Steven T Dekosky; Pascale Barberger-Gateau; Jeffrey Cummings; André Delacourte; Douglas Galasko; Serge Gauthier; Gregory Jicha; Kenichi Meguro; John O'brien; Florence Pasquier; Philippe Robert; Martin Rossor; Steven Salloway; Yaakov Stern; Pieter J Visser; Philip Scheltens Journal: Lancet Neurol Date: 2007-08 Impact factor: 44.182
Authors: Clive Holmes; Delphine Boche; David Wilkinson; Ghasem Yadegarfar; Vivienne Hopkins; Anthony Bayer; Roy W Jones; Roger Bullock; Seth Love; James W Neal; Elina Zotova; James A R Nicoll Journal: Lancet Date: 2008-07-19 Impact factor: 79.321
Authors: Lindsay R Clark; Derek Norton; Sara E Berman; Sterling C Johnson; Barbara B Bendlin; Oliver Wieben; Patrick Turski; Cynthia Carlsson; Sanjay Asthana; Carey E Gleason; Heather M Johnson Journal: J Alzheimers Dis Date: 2019 Impact factor: 4.472