Can Precision Health Reverse the Biogen Setback?

Global pharmaceutical giant Biogen faced a serious setback when it announced its experimental treatment for Alzheimer’s disease (aducanumab) was not effective. There was a lot of focus on Biogen’s stock price hitting the company and shareholders hard, but my thoughts turned to the tens of millions of people worldwide suffering from this terrible disease – and why precision health could be a possible solution.

While there are treatments that temporarily alleviate Alzheimer’s symptoms, there is no known drug that definitively stops the disease from progressing. Considering Alzheimer’s is the fifth leading cause of death for people older than 65, developing ways of treating or preventing it should be a priority for clinicians and drug-makers globally.

So why can’t we seem to find a treatment that works? The problem is the industry continues to test new drugs on patients who are already exhibiting symptoms of Alzheimer’s disease, and therefore, have already had the disease for many years. Could it be those very same drugs – which cost billions to develop but failed in trials – would prove to be very effective if they were given to patients far earlier, before the disease cascade has already reached a point of no return?

 

Recent Discoveries Show a Different Path: Precision Health

The drug, aducanumab, clears amyloid plaques in the brain, which are responsible for damaging nerve cells. But by the time people afflicted with Alzheimer’s have developed amyloid plaques, the disease is already well advanced. The plaques tell clinicians that Alzheimer’s is present, but clearing them does not ultimately prevent the disease itself from progressing. The focus should be on finding signs of Alzheimer’s years before amyloid plaques even materialize and testing treatments on these patients now. Luckily, there is already evidence this can be done.

Two months before the collapse of Biogen’s drug failure, a team of researchers led by Mathias Jucker, professor of cell biology of neurological diseases at the German Center for Neurodegenerative Diseases, found a link between the blood biomarker neurofilament light chain (NfL) and early signs of Alzheimer’s. This is the same biomarker that has also been found to correlate with brain injury or concussion, a potential game-changer when it comes to protecting professional athletes.

The study, reported by CNN, shows a correlation between Alzheimer’s and NfL, finding elevated levels of NfL were detected in people 16 years before symptoms of Alzheimer’s presented. The study is game-changing because of its finding but also because of its innovative approach: rather than looking to the brain, Dr. Jucker and his colleagues looked to the blood.

Those of us who are part of the Powering Precision Health (PPH) movement are keenly aware of how blood biomarkers offer insights into the detection of disease. These recent findings affirm what we have been saying, as I noted in this PPH blog on the study.

 

What’s Next?

How can this research help address the issues highlighted by the failure of Biogen’s Alzheimer’s drug treatment? First, we must move toward detecting this deadly disease earlier in the blood, using NfL as at least one signpost.

When it comes to developing drugs that successfully treat Alzheimer’s and stop its progression, nothing can be guaranteed. But measuring changes in the blood through NfL could allow clinicians to track whether treatments are having an effect or not. And they will be able to do this without waiting for patients to develop the dangerous amyloid plaques.

But even absent the development of a successful drug treatment, finding elevated levels of NfL up to 16 years in advance can allow patients to begin staving off the debilitating symptoms earlier, as well as prepare for the long term. Evidence shows lifestyle changes ranging from exercise to a brain-healthy diet can reduce the risk of Alzheimer’s. The precision health approach is one in which individuals’ baseline of health is measured regularly, so their doctors can detect the progression of disease. In the future, your doctor may be able to detect if you have elevated levels of blood biomarkers that could be correlated with Alzheimer’s a decade or more in advance, so you can adopt these positive changes while there is still time.

I hope the pharmaceutical industry will begin to test their drugs on patients before the disease is full-blown and the damage is irreversible. It’s possible some of the drugs already developed do work, but they are given to patients too late. In the meantime, more research into biomarkers like NfL is crucial.