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Fortschr Neurol Psychiatr 2022; 90(07/08): 352-360
DOI: 10.1055/a-1802-4837
Übersichtsarbeit

Therapieentwicklungen bei der Alzheimer-Krankheit

Therapy Developments in Alzheimerʼs Disease
Timo Grimmer
1   Psychiatry and Psychotherapy, Klinikum rechts der Isar der Technischen Universität München, München, Germany
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Zusammenfassung

Die Entwicklung neuer Therapien zur Behandlung der Alzheimer-Krankheit ist ein Fokus der weltweiten Arzneimittelforschung. Es wird an potenteren Therapien zur symptomatischen Behandlung, insbesondere zur Behandlung von Verhaltensstörungen, aber auch an Medikamenten, die in die Pathophysiologie der Erkrankung eingreifen, geforscht, mit dem Ziel, das Voranschreiten der Alzheimer-Krankheit aufzuhalten oder zumindest zu verlangsamen. Dazu verlagert sich der Schwerpunkt der Identifikation von Menschen mit Alzheimer-Krankheit in Stadien der Prä-Demenz wie das der leichten kognitiven Störung (Mild Cognitive Impairment, MCI oder nahezu gleichbedeutend beginnende Alzheimer-Demenz: prodromal AD) oder gar in asymptomatische Stadien. Bisher ermutigendste Ergebnisse liegen für den Ansatz der passiven Immunisierung mittels monoklonaler Antikörper gegen Aβ42 vor. Bisher gelang es nicht, mit mehreren abgeschlossenen zulassungsrelevanten Studien statistisch signifikante Unterschiede auf den primären Zielparametern zu demonstrieren. Der Antikörper gegen Amyloid Aducanumab erhielt, basierend auf der Reduktion von Amyloid, eine vorläufige Zulassung mit Auflagen in den USA; das Zulassungsverfahren für Europa ist noch im Gange. Die gegenwärtigen pharmakologischen Ansätze zur Behandlung der Alzheimer-Krankheit bieten einen begrenzten symptomatischen Nutzen. Bisher ist noch keine verlaufsverzögernde Behandlung gegen die Alzheimer-Krankheit in Deutschland auf dem Markt. Daher ist zu empfehlen, Patienten, insbesondere in prä-dementiellen Stadien oder im Stadium der beginnenden Alzheimer-Demenz, eine Teilnahme an klinischen Studien zu empfehlen, um die Entwicklung von neuen und besser wirksamen Medikamenten zur Behandlung der Alzheimer-Krankheit, die dann vielen Patienten zu Gute kommen können, zu beschleunigen.

Abstract

The development of new therapies to treat Alzheimer’s disease is a focus of global drug discovery. Research is being conducted into more potent therapies for symptomatic treatment, particularly for behavioral disturbances, but also into drugs that intervene in the pathophysiology of the disease, with the aim of halting or at least slowing the progression of the disease. To this end, the focus of identifying people with Alzheimer’s disease is shifting to stages of pre-dementia such as that of Mild Cognitive Impairment (MCI), almost synonymous with prodromal AD, or even to asymptomatic stages. Currently, passive immunization using monoclonal antibodies against Aβ42 has shown the most encouraging results. However, it has not been possible to demonstrate statistically significant differences on the primary target parameters in multiple completed pivotal trials. The anti-amyloid antibody aducanumab received conditional preliminary approval in the U.S. based on amyloid reduction; approval for its use in Europe is an ongoing process. Current pharmacological treatments of Alzheimer’s disease offer limited symptomatic benefit. No drugs to delay progression of the disease is yet on the market in Germany. Therefore, it is recommended that patients, especially those in pre-dementia stages or at the onset of Alzheimer’s disease, be encouraged to participate in clinical trials in order to help develop new drugs that are more effective in the treatment of this disease and that can then benefit many more patients in the future.

Schlüsselwörter

Alzheimer-Krankheit - Alzheimer-Demenz - Therapien - Studien - Klinische Prüfungen

Key words

Alzheimer’s disease - Alzheimer’s dementia - therapy - studies - clinical trials


Publication History

Received: 09 January 2022

Accepted after revision: 07 March 2022

Article published online:
19 May 2022

© 2022. Thieme. All rights reserved.

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