AD-SMART, a UK trial testing several Alzheimer's drugs at once, could halve the time it takes to find treatments

A new UK trial that tests several Alzheimer's drugs at the same time could more than halve the time it takes to find out whether treatments work, UCL said on 22 October. The trial, AD-SMART, starts with two existing medicines: metformin, used for type 2 diabetes, and atomoxetine, used for attention deficit hyperactivity disorder.

One placebo group, several drugs

AD-SMART is a multi-arm, multi-stage platform trial. Several drugs are tested in parallel against a single group of participants taking a placebo, so more people receive an active treatment than in a traditional trial. Results are checked at regular stages; a drug that shows no benefit can be dropped quickly and a new one added in its place.

Sharing one placebo group is what saves time and money. The same model, used in MND-SMART for motor neuron disease, showed that its first drugs did not work in just over three years, a process that would normally take at least eight, UCL said.

“For too long, Alzheimer's research has moved at the pace of one drug, one trial, one answer.” — Professor Paresh Malhotra, Chief Investigator, Imperial College London and UK Dementia Research Institute

What it means for patients now

Alzheimer's is the most common type of dementia and affects around 600,000 people in the UK, and there are currently no NHS treatments that slow or stop the underlying disease. Neither metformin nor atomoxetine is approved for Alzheimer's, and it is not known whether they help; the trial will test whether they ease memory and thinking problems and help people keep their quality of life.

The first participants have been recruited in Cambridgeshire and Peterborough and in Surrey and Borders, and sites in West London, Edinburgh and Southampton are open. Up to 20 NHS sites should open in the next 12 to 18 months and more than 30 overall. People with a confirmed Alzheimer's diagnosis in the UK can register interest through the AD-SMART trial team or the Alzheimer's Research UK Infoline.

First answers expected in 2030

Researchers aim to recruit 1,200 participants and expect to finish evaluating the first two drugs in 2030, adding more drugs along the way. The trial is led by the UK Dementia Research Institute and Alzheimer's Research UK, with the NIHR, the Medical Research Council and Health Data Research UK. Our explainer on clinical trial phases sets out how drugs move from early tests to approval.