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Combination treatment suggests a comprehensive effect on patients with Alzheimer's disease (AD) - latest study results presented at EFNS

Budapest, Hungary – [September 13, 2011] At a satellite symposium held at the 15th Congress of the European Federation of Neurological Societies1 (EFNS) in Budapest, Professor David Wilkinson (Chairman), Professor Paul Francis, and Professor Josè Luis Molinuevo presented convincing data: combination therapy with a cholinesterase inhibitor (ChEI) and memantine (AXURA® – a non-competitive NMDA receptor antagonist) promises significant advantages in the treatment of AD. There are indications that AD patients retain their cognitive skills, basic everyday activities, social behavior, and communication skills for longer.

Chairman Dr. David Wilkinson, Director of the Memory Assessment and Research Centre (MARC) Southampton, explained that AD patients become physically and mentally dependent on their caregivers. Therefore, a key objective of current treatments is to slow down progression of the disease which can profoundly improve the quality of life of AD patients and their carers. The combination treatment of ChEl donepezil and memantine is one possibility of maintaining the patients condition.

Dr. Paul Francis of Wolfson Centre for Age-Related Disease at King’s College London reported that the NMDA receptor antagonist memantine and the ChEl donepezil have different mechanisms of action. Clinical research with healthy subjects has demonstrated that there is no pharmacokinetic interaction between the two drugs when used in combination. On the contrary, there is preclinical evidence of comprehensive, potentially synergistic effects when the glutamatergic and the cholinergic neurotransmission systems are targeted at the same time.

Combined treatment with memantine and donepezil enhanced ACh release to a greater extent than the sum of either drug on its own.

Dr. Josè Luis Molinuevo, from the Alzheimer’s disease and Other Cognitive Disorders Unit of the Department of Neurology in the Hospital Clinic in Barcelona, underlined Professor Francis’ statement with data from clinical trials and longterm observational studies. The results demonstrate enhanced cognition, function, behavior, and global outcome in patients with AD who received combination therapy with memantine and donepezil.

Compared with ChEl monotherapy, combination therapy appears to further slow the loss of cognitive and functional abilities. Molinuevo pointed to the pre-clinical and clinical evidence that the complementary mechanisms of action seem to be additive. This might be the rationale for the observed improved clinical effects of combination treatment. According to Molinuevo, combination treatment is more effective than monotherapy.

The experts agree that combination therapy is a safe and effective way to treat patients with AD. Taking advantage of the comprehensive effect of memantine and donepezil can slow down disease progression and thus can help reduce the burden on caregivers. Combination therapy seems to be today’s best pharmacological treatment option to preserve cognition and the ability to communicate – enabling patients with AD to retain their independence longer, thus improving the quality of their lives and that of their caregivers.

References 1 Satellite symposium “Combination treatment in Alzheimer’s disease” chaired by David Wilkinson, UK, held at the 15th Congress of the European Federation of Neurological Societies, Monday 12th September 2011, Budapest, Hungary About memantine Memantine is an NMDA-receptor antagonist, the first in a class of AD medications with a unique mechanism of action that focuses on the glutamatergic system. Glutamate is the most common excitatory neurotransmitter in the CNS, and modulation of glutamatergic neurotransmission is a major target for the treatment of Alzheimer's disease.

Memantine was developed by Merz and licensed to Forest for the U.S. to Lundbeck for selected European and international markets, and to Daiichi-Sankyo for Japan. Memantine is marketed under the brands Axura® and Akatinol® by Merz, Namenda® by Forest, Ebixa® by Lundbeck, and Memary® by Daiichi-Sankyo.

Merz Pharmaceuticals GmbH ( Merz Pharmaceuticals, as a member of the Merz Group companies, is an innovative and international healthcare company specializing in the research, development and marketing of pharmaceuticals for the treatment of neurological and psychiatric diseases. Merz is a leader in the field of Alzheimer research and developed memantine as the first drug for the treatment of moderate to severe Alzheimer's disease. Other franchises covered by Merz are hepatology / metabolic diseases and dermatology.

Sibilla Zimmermann-Meinzingen, MD
Merz Pharmaceuticals GmbH
Tel.: +49 (0)69 / 15 03 – 1398
Fax: +49 (0)69 / 15 03 – 91398

Posted: September 2011