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Title: Study Confirms Benefit of Combination Therapy for Alzheimer's Disease
URL: http://www.pslgroup.com/dg/22D3C6.htm
Doctor's Guide
September 22, 2008

BOSTON -- September 22, 2008 -- Extended treatment with Alzheimer's disease drugs can significantly slow the rate at which the disorder advances, and combination therapy with 2 different classes of drugs is even better at helping patients maintain their ability to perform daily activities, according to results from a long-term study of the real-world use of Alzheimer's drugs, published in the July/September issue of Alzheimer Disease and Associated Disorders.

"There has been the impression that these drugs only work for some patients and for a limited amount of time," said lead author Alireza Atri, MD, Department of Neurology, Massachusetts General Hospital (MGH), Boston, Massachusetts.

"One of the problems in judging these drugs has been that patients naturally continue to decline, which can make them think the drugs have stopped working. But our study, which has some unique strengths, indicate that treatment does have long-term benefit."

The researchers were able to conduct a large population study to see how cholinesterase inhibitors (CIs) and memantine work for a full range of patients in real-life situations by analysing data on patients treated at the MGH Memory Disorders Unit since 1990.

Patients in the study included 144 who did not receive any pharmaceutical treatment, 122 treated with CIs alone, and 116 who received both a CI and memantine. As part of their regular treatment, every 6 months patients received standardised assessments of both cognitive abilities and how well they carried out daily activities.

The results showed significant differences in the rate of symptom progression among all 3 groups, with the smallest level of decline in those receiving combination therapy.

While there was an average of 2.5 years' worth of data on the study participants, the researchers analysed the information with a statistical model that predicted probable outcomes for up to 4 years. Although the model's projection of future benefits is conservative, it predicted that the longer patients kept receiving combination therapy, the smaller their rate of decline would become.

"Finding something that could actually modify the course of the disease is the Holy Grail of Alzheimer's treatment, but we really don't know if that is happening or what the mechanism behind these effects might be," said Dr. Atri.

"What we can say now is that providers should help patients understand that the benefits of these drugs are long term and may not be apparent in the first months of treatment. Even if a patient's symptoms get worse, that doesn't mean the drug isn't working, since the decline probably would have been much greater without therapy."

SOURCE: Massachusetts General Hospital

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