Dual Action Of New Drug May Help Against Alzheimer's

August 27, 1999
The Medical Tribune

The dual action of a new drug belonging to a class of compounds called
cholinesterase inhibitors may offer a new way of treating and delaying
some of the symptoms of Alzheimer's disease.

The drug, galantamine, inhibits a neurotransmitter in the brain called
acetylcholinesterase and also stimulates nicotine receptors in the
brain, the same receptors stimulated by smoking tobacco.

"There is data to suggest that stimulating nicotine receptors produces
improvement in learning, memory, attention and concentration. All these
things are very provocative and it raises the issue that if you were
able to stimulate nicotine receptors, not through smoking but with a
drug, it could have a beneficial effect," said Paul R. Solomon, who is a
professor of psychology at Williams College in Williamstown, Mass., and
co-director of the Memory Clinic at the Southwestern Vermont Medical
Center.

Solomon presented his results at the Ninth International Congress of the
International Psychogeriatric Association in Vancouver last week.

In clinical trials, galantamine has been shown to produce an improvement
in the Clinician Interview Based Impression of Change (CIBIC-plus), an
overall assessment of patients' performance, including mental activities
and activities of daily living, based on interviews with patients and
feedback from caregivers.

As is common with other drugs in this class, side effects for patients
on galantamine included nausea and vomiting. However, the side effects
were not long-lasting, often subsiding after a week of treatment.

In a double-blind, placebo-controlled clinical trial involving 636
patients with mild to moderate AD, 423 individuals were assigned to
receive galantamine twice a day for six months and 213 took placebo.
Sixty-two percent were female and the mean age was 75.

Study participants were tested using a scale that measures mental or
cognitive abilities called the Alzheimer's Disease Assessment Scale
(ADAS-cog). Among those who completed the study, patients who took
galantamine achieved cognitive scores that were an average of 3.7 to 3.8
points higher than individuals who received placebo.

Patients taking galantamine experienced an average improvement of 1.7
points over their baseline, or beginning, score. In addition, the
cognitive performance of patients taking placebo declined by an average
of 2 points. Initial data suggest that the first signs of cognitive
improvement are experienced in patients as soon as one week after
reaching their target dose.

"The drug is given twice a day and it seems to be well tolerated, which
is quite important," said Dr. George Grossberg, who is a professor of
psychiatry at St. Louis University School of Medicine in St. Louis. "We
now have patients in their second year of study and it looks very
promising."

Galantamine is now being developed by Janssen Research Foundation, an
affiliate of Johnson & Johnson, under the brand-name Reminyl, and could
be available on the market within 18 months.

"Galantamine is a very interesting drug," said Grossberg. "It is a
derivative of the daffodil plant, which makes it almost like a natural
substance for some people, and that is an attraction." Grossberg, who is
one of the clinical trial investigators for galantamine, said that the
medication "stimulates the nicotinic receptors." He added that these are
"very prominent in the brain and are located throughout the regions of
the brain most affected by Alzheimer's disease."

Copyright 1999 The Medical Tribune News Service.
©1996-1999 Inteli-Health, Inc.
--
Judith Richards, London, Ontario, Canada
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