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Panel 316 - Bringing Innovative Medicines into the Hands of Patients with Alzheimer's disease

Conference Day: 
Day 1 - November 7th 2018
Takeaways and recommendations: 

Bringing Innovative Medicines into the Hands of Patients with Alzheimer's disease

Organized by: Hoffmann-La Roche Ltd.

Speakers: Christin Bexelius, PhD, leads payer related activities to support Roche’s phase III clinical trial programs in Basel, Switzerland; Andrew R. Frank M.D. B.Sc.H. F.R.C.P.(C), Cognitive and Behavioural Neurologist; Medical Director, Bruyère Memory Program, Élisabeth Bruyère Hospital; Dr. K. Jennifer Ingram MD, FRCPC, Founder, Medical Director and Qualified Investigator at the Kawartha Centre – Redefining Healthy Aging; Pauline Tardif, Chief Executive Officer, Alzheimer Society of Canada

Moderator: Soeren Mattke (MD, DSc), Senior Scientist at USC and the Director of the Center for Improving Chronic Illness Care

Takeaways and recommendations

Alzheimer’s and modes of treatment

  • Alzheimer’s disease is a continuum: 60-80% of dementias are Alzheimer’s.

  • Symptomatic treatments are currently available: These drugs do not change the progression of the disease but manage the symptoms of Alzheimer’s Disease.

  • Disease modifying treatments (DMTs) would slow down or stop the progression of the disease.

  • It takes two years to get a proper diagnosis. Doctors exclude all other possibilities before reaching an Alzheimer’s diagnosis.

  • We are getting closer to a DMT in Alzheimer’s. We understand how to diagnose early stages. We have thought leaders looking into how to implement a DMT when there is a therapy. Part of the solution is to adapt methods used in the treatment and management of other diseases.

  • We cannot afford not to pay for early detection. This is an invisible disease.

  • Imagine the impact on long-term care if there was a disease-stopping medication.

  • Set the standards for who needs a diagnostic test at the right level.

The societal side of Alzheimer’s treatment

  • We are talking about people.

  • DMTs will likely be most helpful at the beginning phases of the disease.

  • Stigma and lack of knowledge lead people to avoid seeking a cognitive impairment diagnosis or care.

  • DMTs will be useful to some, but not others. Explaining that a DMT may not be appropriate for you will be a challenge for clinicians.

  • There will be a media flurry around DMTs when they are available.

  • The Canadian healthcare system will need to cover the costs of DMTs, and diagnostics, and expediate their availability.

  • The stigma will be impacted by treatments, but may not be alleviated.

Day 1 and beyond: when a treatment becomes available, how must the healthcare system respond?

  • Determination of adequacy of a DMT for a person will be related to bio-markers. PET scans and lumbar punctures can find bio-markers in pre-symptomatic people.

  • Lumbar punctures are more affordable. Education and dissemination and training will be required to allow primary care providers to do this procedure. If cost of PET scanning came down, many people would prefer that.

  • Oral and intravenous treatments are under investigation. Oral treatments are easier to give, but are all failing. Intravenous would be given on a monthly basis, requiring infrastructure across the country.

  • IV would likely be coming first but would be more expensive; oral medicine may be less expensive.

  • The rate-limiting factor in delivering a DMT is the ability to scale up the lumbar puncture and the PET capacity.

Care by primary care physicians

  • Necessity is the mother of innovation.

  • Private care will be heavily involved in the diagnosis and management of dementia care.

  • Cognitive tests can be delivered in-office, if training is given to staff.

  • Primary care physicians in Canada can do it, are interested in doing it and will do it.

  • Canada is well-positioned to show the rest of the world that the workforce in primary care can and will care for those living with dementia.

  • We cannot scale quickly enough if we only rely on specialists. Primary care physicians are close to being able to handle this care. Primary care can do it, if we help them.

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