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The Addage That Prevention Is Better Than Cure In Alzheimer’s and Dementia
The searche for the “cure” has been disapointing. The protocols for recruitment in clinical tests for most of the players in the game have gone from including Moderate Dementia patients to only going after those having scores on above 20 MMSE or Mild Dementia. The proponents of the Plaque Theory look forward to treat only those with Mild Dementia as the paradim shifts to Prevention from seeking the “cure”. This proves how devastatoin these disease is on the CNS. As dementia is a disease of old age, its epidemiology is connected with morbidity. That is because the people afflicted with dementia die mostly of other causes than dementia or Alzheimer’s itself. There is a natural deterioration in MMSE scores and the more devastation deterioration leading ultimately to diagnosis (disease first, diagnosis later). The nature of this deterioration is the loss of keeping up with daily living skills and abilities. A person needs to be institutionalized or cared for at great cost to care givers and society.
Look Into Epidemiology Of Dementia And Alzheimer’s By Extension
I suggest first reading post I posted previously on this subject. The references are given there. https://piotrpeterblog.com/2021/04/11/the-ideal-dementia-drug-and-dementia-patients-population/
Just about 1/3 of people with dementia dies with Severe Dementia, and just 10% is diagnosed very early. Most diagnoses are given to people in their eighties and average MMSE scores for those are about 18. This is region of Moderate Dementia. The data given in the reference being the basis of this post points to need to prevent deterioration of the aging poulation and not just finding the “cure”.
The One Year Trial vs. The Preventative
Anavex with Blarcamesine has finished a 48 week trial with patients all above 20 MMSE. Soon the data will be released to the public, although I believe it can take few months. This data will be scrutinized by the investing public through the lense of ADAS-Cog11 scores and the term of “statistically significant”. For me the most significant is the data on the Open Label Extension for Phase 2a and Phase 2b/3. The market has yawn when $AVXL ran studies on prevention in murine and rat models. Epidemiologically, it is the prevention which is the genuine article here. I posted previously on this thread. Here is a link to the post. https://piotrpeterblog.com/2021/06/12/is-there-more-than-just-alzheimers-parkinsons-and-rett-syndrome-in-blarcamesine-bag-of-tricks-avxl/
The progression of importance of results from those trials and OLE extensions is: Improving and holding Daily Living and Cognitive scores; Preventing Deterioration into Dementia of healthy subjects so that they can hold their own against dementia and disability.
The trial can address the first priority. FDA is geared to look for this, improved scores in 48 weeks and statistical significance. The other are addressed by the OLE extensions. For anybody going into partnership with Anavex this data has tremendeous value though the FDA approval can be done primarily on basis of 48 week trial. The real profit can be in prevention.
Dr. Missling has placed the number of those who are still after 3 years in th ePhase2a OLE “between 10 and 21”. See my post above to interpret this ambiguity. Dr Missling acted as if he could not reveal the truth but could not lie either. see the post for the implication of these numbers. Similarly OLE of Phase2b/3 can partially corroborate these results. I hope that any potentail partner or FDA will not be blind to these far reaching benefits of Blarcamesine.
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