Combination therapy for Alzheimer's disease: Are we ready?

Clinical trials for Alzheimer’s disease (AD) have been dominated by investigations of monotherapies. This, and an expanding gap between the present and the last approval by the U.S. Food and Drug Administration of an Alzheimer’s treatment, has heightened the call to investigate combination therapy for AD. Thus, it was no surprise that for its Spring 2018 meeting, the Alzheimer’s Association Research Roundtable took up the topic of combination therapy, bringing together experts from the pharmaceutical industry, academia, and regulatory agencies to consider whether the time is right for moving forward with combinatorial approaches. Many factors support the development of combination therapies for AD, including the emerging consensus that AD arises from the interaction of multiple complex and overlapping pathophysiological pathways. Combination therapy has also become the favored treatment for many other complex diseases such as cancer, heart disease, and HIV/AIDS. These and other factors have galvanized many in the AD community to push for more innovative treatment alternatives. “We have to be more aggressive and bolder, and I think combination therapy is one way to do that” said Reisa Sperling, MD, director of the Center for Alzheimer Research and Treatment at Brigham and Women’s Hospital and Massachusetts General Hospital. Research Roundtable co-chair Stephen Salloway, MD, director of the Memory and Aging Program at Butler Hospital in Providence, Rhode Island, concurred, noting that progress will require “building an army to fight AD.” This army, he said, will comprise a partnership of individuals living with dementia and families, concerned citizens, and scientists focused on both great science and broad civic engagement to change the narrative from fear to action.