June 28, 2004
A new study from the U.K. questions the benefits and cost-effectiveness of Aricept, a medicine commonly used to improve thinking skills during the earlier stages of Alzheimer's disease. Researchers reported that the drug produced modest improvements in memory and thinking, as shown in earlier studies, and that these improvements were sustained for at least two years. However, the drug did little to stop the downward progression of disease. Nor did it ease the burden on caregivers or keep those with Alzheimer's out of a nursing home. The investigators called for more cost-effective ways of managing people with the disease and continued research into more effective treatments for the mind-ravaging ailment.
The five-year study, from the University of Birmingham, followed 565 men and women with mild to moderate Alzheimer's who were being cared for at home. Half were given Aricept (donepezil), a popular medication for the treatment of early Alzheimer's. The other half received a look-alike placebo (dummy pill).
Those persons taking the drug did a little bit better on memory tests. However, Aricept did not delay the relentless downward spiral of the disease. Members of both groups got steadily less able to care for themselves, and similar numbers of patients in both groups entered nursing homes. Caregivers also had to spend about as much time and energy caring for patients with Alzheimer's regardless of whether they were taking the drug or not.
Aricept belongs to a class of drugs known as "cholinesterase inhibitors". Other drugs in the group include Exelon (also called rivastigmine) and Reminyl (galantamine). Only Aricept was tested in the current study. Recently, it was reported that many patients fail to respond to any of these drugs initially, but that favorable responses can be encouraged if a patient is switched to a different cholinesterase inhibitor from among the three. Furthermore, it has also been shown that very often a cholinesterase inhibitor that loses its effectiveness can be replaced with another cholinesterase inhibitor that restores effectiveness. The present study did not take these observations into consideration.
Nevertheless, Professor Richard Gray, director of the medical unit where the study was conducted, concluded that, "researchers need to find more effective drugs than cholinesterase inhibitor. But we shouldn't just focus on drugs. We also need to find more effective ways of supporting people with Alzheimer's disease and their carers."
In addition to drugs, other forms of treatment can offer benefits for those with Alzheimer's and those who care for them. Research at New York University and other medical centers, for example, has shown that counseling and support groups offer lasting benefits for those with the disease and caregivers alike.
The current study is only one of many showing various degrees of effectiveness for drugs and other therapies. We at the Fisher Center recommend that anyone with Alzheimer's and their caregivers consult their doctors before eliminating any medication as a treatment option. At the Fisher Center for Alzheimer's Research Foundation, the search for a cure continues.
AD2000 Collaborative Group, University of Birmingham Clinical Trials Unit: "Long-term donepezil treatment in 565 patients with Alzheimer's disease (AD2000): randomized double-blind trial." The Lancet Volume 363, Number 9427, 26 June 2004.