The University of Southampton
University of Southampton Institutional Repository

The Edinburgh Consensus: preparing for the advent of disease-modifying therapies for Alzheimer’s disease

The Edinburgh Consensus: preparing for the advent of disease-modifying therapies for Alzheimer’s disease
The Edinburgh Consensus: preparing for the advent of disease-modifying therapies for Alzheimer’s disease

Context:

This commentary discusses the implications of disease-modifying treatments for Alzheimer’s disease which seem likely to appear in the next few years and results from a meeting of British experts in neurodegenerative diseases in Edinburgh. The availability of such treatments would help change public and professional attitudes and accelerate engagement with the prodromal and preclinical populations who might benefit from them. However, this would require an updated understanding of Alzheimer’s disease, namely the important distinction between Alzheimer’s disease and Alzheimer’s dementia.

Consensus:

Since treatments are likely to be most effective in the early stages, identification of clinically relevant brain changes (for example, amyloid burden using imaging or cerebrospinal fluid biomarkers) will be crucial. While current biomarkers could be useful in identifying eligibility for new therapies, trial data are not available to aid decisions about stopping or continuing treatment in clinical practice. Therefore, effective monitoring of safety and effectiveness when these treatments are introduced into clinical practice will be necessary to inform wide-scale use. Equity of access is key but there is a tension between universal access for everyone with a diagnosis of Alzheimer’s disease and specifying an eligible population most likely to respond. We propose the resources necessary for an optimal care pathway as well as the necessary education and training for primary and secondary care.

Conclusion:

The majority of current services in the UK and elsewhere would not be able to accommodate the specialist investigations required to select patients and prescribe these therapies. Therefore, a stepped approach would be necessary: from innovating sentinel clinical-academic centres that already have capacity to deliver the necessary phase IV trials, through early adoption in a hub and spoke model, to nationwide adoption for true equity of access. The optimism generated by recent and anticipated developments in the understanding and treatment of Alzheimer’s disease presents a great opportunity to innovate and adapt our services to incorporate the next exciting development in the field of dementia.
1758-9193
Ritchie, Craig W.
6c9d9049-b42c-468c-ac5f-cd88041761de
Russ, Tom C.
e1750d17-78d5-444c-b5c2-4c680aeed263
Banerjee, Sube
c89df0e0-46cf-482b-ac93-6c39333c93b5
Barber, Bob
fe681e5c-dd5b-4838-8770-8cc2a9303c4b
Boaden, Andrew
41b641b2-94eb-4a46-afc0-3a8e1e78665a
Fox, Nick C.
766c3cb6-f888-4c9f-872c-e684ae2c6fcb
Holmes, Clive
ada5abf3-8459-4cf7-be40-3f4e9391cc96
Isaacs, Jeremy D.
87054aa1-e301-4080-8624-737d465e337e
Leroi, Ira
896712d8-4a91-407c-9410-14c92ac35bbe
Lovestone, Simon
8c74cdb9-c6cc-4f60-8ad4-beaf5b526040
Norton, Matt
3fdf93cd-40f1-49ce-9f21-5e846ce232a0
O'Brien, John
0906821d-4431-47e6-8155-27de5d7f9612
Pearson, Jim
463d4022-dd75-4786-9746-d149320dd8d7
Perry, Richard
b3dbda38-8eb0-4e44-8904-8630f10e0436
Pickett, James
78d98730-ebe1-45b2-b1b3-c90e6dc34d30
Waldman, Adam D.
a80dd998-d424-4831-ab89-7fc95ee34aac
Wong, Wai Lup
8b1f6da8-d955-4e08-b853-eb56e08c87b3
Rossor, Martin
bb28f1d3-34b7-46b8-9d13-02e4bfc0affc
Burns, Alistair
3b42ceb2-cc8b-4159-807b-fe1bc095f723
Ritchie, Craig W.
6c9d9049-b42c-468c-ac5f-cd88041761de
Russ, Tom C.
e1750d17-78d5-444c-b5c2-4c680aeed263
Banerjee, Sube
c89df0e0-46cf-482b-ac93-6c39333c93b5
Barber, Bob
fe681e5c-dd5b-4838-8770-8cc2a9303c4b
Boaden, Andrew
41b641b2-94eb-4a46-afc0-3a8e1e78665a
Fox, Nick C.
766c3cb6-f888-4c9f-872c-e684ae2c6fcb
Holmes, Clive
ada5abf3-8459-4cf7-be40-3f4e9391cc96
Isaacs, Jeremy D.
87054aa1-e301-4080-8624-737d465e337e
Leroi, Ira
896712d8-4a91-407c-9410-14c92ac35bbe
Lovestone, Simon
8c74cdb9-c6cc-4f60-8ad4-beaf5b526040
Norton, Matt
3fdf93cd-40f1-49ce-9f21-5e846ce232a0
O'Brien, John
0906821d-4431-47e6-8155-27de5d7f9612
Pearson, Jim
463d4022-dd75-4786-9746-d149320dd8d7
Perry, Richard
b3dbda38-8eb0-4e44-8904-8630f10e0436
Pickett, James
78d98730-ebe1-45b2-b1b3-c90e6dc34d30
Waldman, Adam D.
a80dd998-d424-4831-ab89-7fc95ee34aac
Wong, Wai Lup
8b1f6da8-d955-4e08-b853-eb56e08c87b3
Rossor, Martin
bb28f1d3-34b7-46b8-9d13-02e4bfc0affc
Burns, Alistair
3b42ceb2-cc8b-4159-807b-fe1bc095f723

Ritchie, Craig W., Russ, Tom C., Banerjee, Sube, Barber, Bob, Boaden, Andrew, Fox, Nick C., Holmes, Clive, Isaacs, Jeremy D., Leroi, Ira, Lovestone, Simon, Norton, Matt, O'Brien, John, Pearson, Jim, Perry, Richard, Pickett, James, Waldman, Adam D., Wong, Wai Lup, Rossor, Martin and Burns, Alistair (2017) The Edinburgh Consensus: preparing for the advent of disease-modifying therapies for Alzheimer’s disease. Alzheimer's Research & Therapy, 9 (85). (doi:10.1186/2Fs13195-017-0312-4).

Record type: Article

Abstract


Context:

This commentary discusses the implications of disease-modifying treatments for Alzheimer’s disease which seem likely to appear in the next few years and results from a meeting of British experts in neurodegenerative diseases in Edinburgh. The availability of such treatments would help change public and professional attitudes and accelerate engagement with the prodromal and preclinical populations who might benefit from them. However, this would require an updated understanding of Alzheimer’s disease, namely the important distinction between Alzheimer’s disease and Alzheimer’s dementia.

Consensus:

Since treatments are likely to be most effective in the early stages, identification of clinically relevant brain changes (for example, amyloid burden using imaging or cerebrospinal fluid biomarkers) will be crucial. While current biomarkers could be useful in identifying eligibility for new therapies, trial data are not available to aid decisions about stopping or continuing treatment in clinical practice. Therefore, effective monitoring of safety and effectiveness when these treatments are introduced into clinical practice will be necessary to inform wide-scale use. Equity of access is key but there is a tension between universal access for everyone with a diagnosis of Alzheimer’s disease and specifying an eligible population most likely to respond. We propose the resources necessary for an optimal care pathway as well as the necessary education and training for primary and secondary care.

Conclusion:

The majority of current services in the UK and elsewhere would not be able to accommodate the specialist investigations required to select patients and prescribe these therapies. Therefore, a stepped approach would be necessary: from innovating sentinel clinical-academic centres that already have capacity to deliver the necessary phase IV trials, through early adoption in a hub and spoke model, to nationwide adoption for true equity of access. The optimism generated by recent and anticipated developments in the understanding and treatment of Alzheimer’s disease presents a great opportunity to innovate and adapt our services to incorporate the next exciting development in the field of dementia.

Text
The Edinburgh Consensus preparing for the advent of disease - Version of Record
Available under License Creative Commons Attribution.
Download (426kB)

More information

Accepted/In Press date: 1 September 2017
e-pub ahead of print date: 26 October 2017

Identifiers

Local EPrints ID: 416064
URI: https://eprints.soton.ac.uk/id/eprint/416064
ISSN: 1758-9193
PURE UUID: c7322c9c-5536-46de-ba85-947ecb4a00ca
ORCID for Clive Holmes: ORCID iD orcid.org/0000-0003-1999-6912

Catalogue record

Date deposited: 01 Dec 2017 17:30
Last modified: 03 Dec 2019 01:55

Export record

Altmetrics

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of https://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×