When One Door Closes

What the Failure of Biogen’s Aducanumab Tells Us About Alzheimer’s — Risk Reduction is Still Our Best Weapon

Today I serve as Neurotrack’s Head Writer. But three years ago, in a different professional incarnation, I had the privilege of sitting in a packed conference room with a bright, articulate representative from the pharmaceutical company Biogen on the day she presented us with her company’s ambitious next-phase plans for aducanumab, the drug Biogen and so many others in the scientific community were hopeful would be the cure for Alzheimer’s. At that time, they were seeking subjects for the Phase 3 trial.

I’d heard of Alzheimer’s disease back then, of course, but no one in my family had had it, and no one I’d ever known had been struck by it, so for a week I did a deep dive into the science: the amyloid plaques that are its signposts, the fear and sadness when it first strikes its victims, the burden on family and caregivers once it progresses.

Aducanumab is a monoclonal antibody derived from blood collected from a donor population of healthy elderly subjects: meaning, they either lacked signs of cognitive decline or showed unusually slow decline. The hope was that these antibodies would target the brain-ravishing protein fragments, beta amyloids, and subsequently destroy them.

Those hopes were dashed last month, when Biogen announced it was halting the trial.

Sadly, frustratingly, this has been the fate of all pharmaceutical attempts to slow or halt the progression of the disease after it strikes. Meanwhile, the statistics on Alzheimer’s continue to expand exponentially. Today, 5.8 million Americans are living with Alzheimer’s. By 2050, that number is expected to rise to nearly 14 million. In 2019, Alzheimer’s and other dementias will cost the U.S. $290 billion. By 2050, those costs are predicted to rise as high as $1.1 trillion. Yes, trillion.

In other words, now that Biogen has failed—aducanumab had been closely watched and touted as Alzheimer’s white horse—we are once again on the cusp of a worldwide epidemic with no pharmaceutical cure in sight.

Just prior to joining Neurotrack last year, I ran into an old family friend, stricken with Alzheimer’s. She had no idea who I was. Her husband, who was supposed to have been enjoying his retirement with her, now spends his days caring for a wife who no longer recognizes him as her husband. When I heard that Neurotrack’s aim is to attack Alzheimer’s before it attacks the brain, I was intrigued: could tracking cognitive function combined with lifestyle changes such as diet, exercise, sleep, and brain challenges reduce the number of years before onset of disease? Early studies seem to point in this direction.

While we at Neurotrack were devastated to hear that aducanumab was another pharmaceutical bust, it has only increased our drive to focus on risk reduction before the onset of disease. Dementia is rarely a single pathology-driven disease. So a one-size-fits-all, one-cognitive-impairment-fits-all cure was always a dubious goal at best. Every day, we are learning more and more not only about the complexity of Alzheimer’s disease but also about how various lifestyle interventions might delay its onset. While our Memory Health Program is not a drug and never will be, it can, we believe, provide an opportunity for individual risk reduction of cognitive decline. In other words, our mission is now clearer than ever: we must fight this scourge at its roots before it roots itself into the brain. There is, at this time, literally no other option.

Deborah Copaken
Deborah Copaken

Deborah Copaken, Head Writer at Neurotrack, is also a New York Times bestselling author of The Red Book and Shutterbabe, among others. Her work appears regularly in The Atlantic as well as in The New Yorker, The New York Times, The Nation, The Washington Post, and many others.