UK trial tests ADHD drug and diabetes pill against Alzheimer's
Off-patent generics enter multi-arm Ad-Smart study after amyloid antibodies rejected by NHS, nobody profits from proving old drugs work
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Burnham’s father Roy died in September (Reuters)
Reuters
Alzheimer’s is the most common type of dementia, affecting around 600,000 people in the UK (Getty/iStock)
Getty/iStock
A new British trial will test an ADHD drug and a diabetes pill against Alzheimer's, the two cheapest and least glamorous candidates imaginable. The Ad-Smart study, run by the UK Dementia Research Institute with backing from Alzheimer's Research UK and the Government, begins with atomoxetine — prescribed for attention deficit hyperactivity disorder — and metformin, the off-patent mainstay of type 2 diabetes treatment. Recruitment has started at two NHS trusts, with up to 20 sites planned over the next 18 months and more than 1,000 participants expected.
The trial's design is its real innovation. Rather than testing one drug over a decade, Ad-Smart evaluates several treatments concurrently and drops those that show no promise. Chief investigator Professor Paresh Malhotra of the UK Dementia Research Institute says the setup could more than halve the time needed to evaluate Alzheimer's drugs, with first conclusions expected by 2030. Existing evidence suggests atomoxetine affects mechanisms linked to further degeneration, while metformin has shown potential across specific disease pathways. Additional therapies, both repurposed and novel, will be added over time.
Behind the design choice lies an uncomfortable economics. The patented amyloid antibodies lecanemab and donanemab advanced the field but were rejected for NHS use — too expensive for what they deliver. Cheap, off-patent generics like atomoxetine and metformin have no patent-holder with a reason to fund trials, which is precisely why public money has to step in. Nobody profits from proving an old drug works.
Prime Minister Andy Burnham, whose father Roy died with the condition in September, has made dementia research a national priority and says he wants Britain to lead the world in breakthroughs. Alzheimer's affects roughly 600,000 people in the UK, and the trial will ask a modest question: whether treatments help with memory and thinking, and whether people can keep a good quality of life.
The first results will arrive in 2030 — from two drugs that have been on pharmacy shelves for decades.