Tuesday, 13 March 2012
On Sunday 11 March 2012, 60 Minutes New Zealand reported on the practice of a private medical clinic in California. Dr Edward Tobinick, a board-certified internal medicine specialist, has found, since about 2004, that injecting a medicine called Etanercept (or Enbrel) overlying the spine in the back of the neck (“perispinal administration”) helps people with some kinds of dementia. Alzheimers New Zealand scientific advisor, Dr Matthew Croucher comments on this treatment.
“The programme showed two cases with apparently good short-term results, one of whom was an Australian diagnosed with dementia of Alzheimer type and one of whom was an American diagnosed with Primary Progressive Aphasia, quite a different disease from Alzheimer’s disease. Dr Tobinick does not claim this treatment is a cure, but he has published data reporting that regular injections can make the symptoms better and that effects can occur within minutes of treatment. Watching the programme, the benefits seen certainly seemed wonderful for the couples involved but were well short of a cure.
Etanercept is a powerful inhibitor of one of the body’s chemicals involved in regulating inflammation called Tumour Necrosis Factor Alpha or TNF-α. It is available in New Zealand from specialists in rheumatology and dermatology for the treatment of severe and treatment-resistant types of arthritis and psoriasis and is very expensive. Although etanercept is widely used throughout the world and has a substantial safety record, there can be quite significant side effects from treatment, especially for older people with existing lung or heart disease.
There is genuine scientific interest in the role of TNF-α and other markers of inflammation in Alzheimer’s Disease and other dementias and several clinical trials are being conducted around the world to try and find medicines that will be helpful for people with dementia, either to prevent the dementia occurring or to treat the symptoms once it occurs. It is not likely that studies will yield cures, but there is hope that they may be able to dramatically slow the progression of some diseases that cause dementia and also improve symptoms.
There have been no large studies of Etanercept for dementia. A small trial of 15 people (12 on Etanercept and 3 on placebo), administered before the specialized perispinal method invented by Dr. Tobinick was developed, was reported by Bohac and colleagues to the Alzheimer’s International Conference in 2002 but did not find any benefit for the Etanercept group over 24 weeks. On the other hand, Tobinick has published a series of 15 cases showing benefits when given etanercept by the perispinal administration method. A larger randomised controlled trial called “STEADI-09” is currently recruiting patients in England and may be in a position to publish results in 2014. No one else has yet published clinical trial results on the use of this medicine in dementia, but two independent randomized clinical trials of epidural(perispinal) etanercept for sciatica, a method Dr. Tobinick also invented, have both given positive results. There are calls for other studies to be run, but it is unlikely that New Zealand researchers will be invited to participate in trials at this stage.
The search for cures and much better medical treatments for dementing illnesses continues. Here in New Zealand, specialist continue to watch the literature closely and to keep up to date with international trends, but progress is very slow. We need to remember that while these tantalising steps towards progress are painfully slow, in the meantime the heart of dementia care is excellent care, not fancy technology. Perhaps that will always be the case. At the moment, we should invest our energy in lobbying people in power to improve care and carer support for dementia, and continue to help each other with the difficult job of living with dementia.”
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