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Home > Market Research > Indication Areas > Alzheimer's Disease: Current Treatment Practices and Opportunities, 2010
This report (see Brochure) presents the findings of a comprehensive survey of current clinical practices in the treatment of Alzheimer�s Disease (AD). This was carried out following the participation of more than 220 physicians, practicing predominantly in the US. The purpose of this study was to establish current everyday drug treatment practices for AD and how current drug classes, individually and in combination, are prescribed for mild, moderate and severe stages of the disease. As part of this survey, more than 200 physicians also reported on the principal challenges of treating this disease and these findings are presented, analysed and discussed in this report.
The treatment of AD remains an area of significant unmet need, with therapies based largely on two drug classes: the cholinesterase inhibitors and the NMDA receptor antagonists. These drugs target the symptoms of the disease, however there is considerable need for disease-modifying therapies. Other therapeutic agents are used to treat this disease, which have also been surveyed as part of this work. This survey investigated the use of these drug classes for the treatment of mild, moderate and severe AD, as well as examining the use of drug combinations. While available drugs to treat AD are limited, current practices in how they are used and combined in treating mild, moderate and severe disease, vary greatly. This survey has examined current treatment practices, which includes off-label use.
In a therapeutic field where treatments for AD are very limited, physicians seek to extent their understanding in this area in an effort to better understand how current drugs and combinations can best be used to target mild, moderate and severe stages. Knowledge in these areas is also important to drug developers, who seek a better understanding of patient needs and outcomes as part of their own efforts to develop more effective therapies. The present survey was carried out to meet interest in these areas. This report presents an analysis of the survey findings and includes:
1. Clinics: comprehensive details of current treatments for AD, provided by more than 220 clinics.
2. Markets and opportunities: in-depth information and analysis relevant to therapeutic markets and opportunities in the AD field.
3. Physicians: of the participants, 92% practiced in the US, 2% practiced in Canada and 6% in other countries. Of these, 28% worked in a geriatric department, 20% practiced in a hospital general department, 15% worked in a general practice and 10% worked in a university research/clinical practice. Approximately 90% of the participants worked as Geriatricians and 5% were General Physicians.
4. Disease stages: estimates of the percentage (%) of AD patients treated by study participants for mild, moderate or severe disease.
5) Mild AD: estimates of the percentage (%) of mild AD patients who are prescribed Cholinesterase Inhibitors (e.g. donepezil, Aricept®; rivastigmine, Exelon®; galantamine, Reminyl®; NMDA Receptor Antagonist (e.g. memantine - Namenda®, Axura®, Ebixa®; Nootropics (e.g. piracetam - Nootropil®); and other drug classes.
6) Mild AD: first choice and second choice drug combinations of two or more of the drug classes Cholinesterase Inhibitors; NMDA Receptor Antagonist; Nootropics; Colostrinin; Vitamins and other drugs for the treatment of mild disease.
7) Moderate AD: estimates of the percentage (%) of moderate Alzheimer�s disease patients who are prescribed Cholinesterase Inhibitors (e.g. donepezil, Aricept®; rivastigmine, Exelon®; galantamine, Reminyl®; NMDA Receptor Antagonist (e.g. memantine - Namenda®, Axura®, Ebixa®; Nootropics (e.g. piracetam - Nootropil®); and other drug classes.
8) Moderate AD: first and second-choice drug combinations of two or more of the drug classes Cholinesterase Inhibitors; NMDA Receptor Antagonist; Nootropics; Colostrinin; Vitamins and other drugs for the treatment of moderate disease.
9) Severe AD: estimates of the percentage (%) of severe AD patients who are prescribed Cholinesterase Inhibitors (e.g. donepezil, Aricept®; rivastigmine, Exelon®; galantamine, Reminyl®; NMDA Receptor Antagonist (e.g. memantine - Namenda®, Axura®, Ebixa®; Nootropics (e.g. piracetam - Nootropil®); and other drug classes.
10) Severe AD: first and second-choice drug combinations of two or more of the drug classes Cholinesterase Inhibitors; NMDA Receptor Antagonist; Nootropics; Colostrinin; Vitamins and other drugs for the treatment of severe disease.
11) The principal challenges and issues encountered in the treatment of Alzheimer�s disease.
Background to Alzheimer�s disease
A prevalence study in 2005 estimated there were 24·3 million people suffering from dementia globally, with 4·6 million new cases added every year. In the absence of a cure, the study suggested dementia sufferers will double every 20 years to 81·1 million by 2040. Of those reported to be suffering from dementia, 60% were living in developing countries, a figure expected to rise to 70% by 2040. Rates of increase of dementia are not uniform, and between 2001 and 2040 were projected to increase by 100% in developed countries and by more than 300% in India, China, and their south Asian and western Pacific neighbours. More than 50% of these dementia cases are due to AD.
Today, approximately five million Americans suffer from AD, a figure expected to rise to 14 million by 2050 if a cure is not found. One in eight persons in the US over the age of 65 and nearly half of those over 85 have AD. Direct and indirect costs of AD and other dementias in the US amount to more than $148 billion annually. It is estimated that 10 million Americans are caring for a person with AD or another dementia, one third of whom are over the age of 60. It is estimated the worldwide costs for dementia care are over $315 billion annually.
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Table of Contents
Executive Summary
Chapter 1 Background p.10
1. Alzheimer's disease
1.1 Statistics and costs
1.2 Treatment
1.3 This report
Chapter 2 The Survey p.14
2.1 The survey
2.2 Survey questions
Chapter 3 Survey Participants p.18
3.1 Summary
3.2 Overview
3.3 Findings
Chapter 4 Alzheimer's Disease Patients p.23
4.1 Summary
4.2 Overview
4.3 Findings
Chapter 5 Drug Classes Prescribed For Mild Alzheimer's Disease p.28
5.2 Overview
5.3 Findings
Chapter 6 Drug Combinations used in Mild Alzheimer's Disease p.35
6.1 Summary
6.2 Overview
6.3 Findings
Chapter 7 Drug Classes Prescribed for Moderate Alzheimer's Disease p.41
7.1 Summary
7.2 Overview
7.3 Findings
Chapter 8 Drug Combinations used in Mild Alzheimer's Disease p.48
8.1 Summary
8.2 Overview
8.3 Findings
Chapter 9 Drug Classes Prescribed for Severe Alzheimer's Disease p.53
9.1 Summary
9.2 Overview
9.3 Findings
Chapter 10 Drug Combinations used in Severe Alzheimer's Disease p.60
10.1 Summary
10.2 Overview
10.3 Findings
Chapter 11 Study Participants p.65
Chapter 12 Discussion p.72
12.1 Treatment practices
12.2 Challenges and issues
12.3 Opportunities
Appendix 1 pp.78-104
Figures
Figure 3.1 Participant countries
Figure 3.2 Participant organisations
Figure 3.4 Participant physicians
Figure 4.1 Percentage of patients with mild Alzheimer's disease
Figure 4.2 Percentage of patients with moderate Alzheimer's disease
Figure 4.3 Percentage of patients with severe Alzheimer's disease
Figure 4.4 Mean Percentage of patients with mild, moderate or severe Alzheimer's disease
Figure 5.1 Percentage of mild Alzheimer's disease patients prescribed a cholinesterase inhibitors
Figure 5.2 Percentage of mild Alzheimer's disease patients prescribed an NMDA receptor antagonist
Figure 5.3 Percentage of mild Alzheimer's disease patients prescribed a nootropic
Figure 5.4 Percentage of mild Alzheimer's disease patients prescribed other drugs
Figure 5.5 Percentage of mild Alzheimer's disease patients prescribed all drugs
Figure 6.1 First choice drug combinations used in the treatment of mild Alzheimer's disease
Figure 6.2 Second choice drug combinations used in the treatment of mild Alzheimer's disease
Figure 7.1 Percentage of moderate Alzheimer's disease patients prescribed a cholinesterase inhibitors
Figure 7.2 Percentage of moderate Alzheimer's disease patients prescribed an NMDA receptor antagonist.
Figure 7.3 Percentage of moderate Alzheimer's disease patients prescribed a nootropic.
Figure 7.4 Percentage of moderate Alzheimer's disease patients prescribed other drugs.
Figure 7.5 Percentage of moderate Alzheimer's disease patients prescribed all drugs
Figure 8.1 First choice drug combinations used in the treatment of moderate Alzheimer's disease
Figure 8.2 Second choice drug combinations used in the treatment of mild Alzheimer's disease
Figure 9.1 Percentage of severe Alzheimer's disease patients prescribed a cholinesterase inhibitors
Figure 9.2 Percentage of severe Alzheimer's disease patients prescribed an NMDA receptor antagonist.
Figure 9.3 Percentage of severe Alzheimer's disease patients prescribed a nootropic.
Figure 9.4 Percentage of severe Alzheimer's disease patients prescribed other drugs.
Figure 9.5 Percentage of severe Alzheimer's disease patients prescribed all drugs
Figure 10.1 First choice drug combinations used in the treatment of severe Alzheimer's disease
Figure 10.2 Second choice drug combinations used in the treatment of severe Alzheimer's disease
Figure 12.1 Percentage of mild Alzheimer's disease patients prescribed cholinesterase inhibitors
Figure 12.4 Top-10 limitations and issues encountered in the treatment of Alzheimer's disease
Tables
Table 3.1 Participant organisations
Table 5.1 Other treatments used for patients with mild Alzheimer's disease
Table 6.1 First choice drug combinations used in the treatment of mild Alzheimer's disease
Table 6.2 Second choice drug combinations used in the treatment of mild Alzheimer's disease
Table 7.1 Other treatments used for patients with moderate Alzheimer's disease
Table 8.1 First choice drug combinations used in the treatment of moderate Alzheimer's disease
Table 8.2 Second choice drug combinations used in the treatment of moderate Alzheimer's disease
Table 9.1 Other treatments used for patients with moderate Alzheimer's disease
Table 10.1 First choice drug combinations used in the treatment of severe Alzheimer's disease
Table 10.3 Second choice drug combinations used in the treatment of severe Alzheimer's disease
Table 11.1 Study Participants
Table 12.1 The percentage of mild, moderate and severe AD patients who are prescribed cholinesterase inhibitors, NMDA receptor antagonists, nootropics and other drugs
Table 12.2 The percentage of physicians prescribing cholinesterase inhibitors and NMDA receptor antagonists to 50% or less of their mild, moderate or severe Alzheimer's disease patients.
Table 12.3 First and second choice prescribing patterns for mild, moderate or severe Alzheimer's disease using either cholinesterase inhibitors of NMDA receptor antagonists, independently of other drugs.
Table 12.4 Limitations and issues encountered in the treatment of Alzheimer's disease
Appendix 1. Responses provided by study participants to the question: What are the major issues and challenges associated with the treatment of Alzheimer's disease? Responses given by physicians to this question (which in some cases may be brief, informal or abbreviated) are presented verbatim, except in those some cases where minor grammatical or typographical corrections have been made for reasons of clarity.
For full details, please email keithw@cmsinfo.com
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