Comment by ineedasername | Hacker News Reader

Comment by ineedasername | Hacker News Reader

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I'm surprised that a range of existing drugs with neuroprotective capabilities haven't received more attention. The cynic in me says it's because many of them are cheap generics that have little financial upside for large pharmaceuticals.

As an example, a range of anticonvulsant drugs exhibit neuroprotective effects. Depakote appears to be the best studief of the lot for this, but that's not saying much.Something like lamotrogine has similar results with lower side effect profile. These are widely used drugs for diseases like epilepsy, but they are also used for a wide range of mental health diseases where psychosis and dementia are issues because they are very effective in those areas as well. A nice bonus in treating another disease with similar neuro symptoms.

This probably wouldn't be front-line treatment, but alongside amyloid reducing medications could form a powerful combination. The biggest obstacle might be the side effects, but judicial use in the earliest stages or in high risk poulations would probably be useful. The problem is right now the data is limited to very small studies or anecdotal case studies of individual patients that were treated off label.

> The cynic in me says it's because many > of them are cheap generics that have > little financial upside for large > pharmaceuticals.

The patent is for problem + solution. You can patent many solutions for one problem and also a solution for many problems.

If they prove, say, that vitamin C stops Alzheimer's then they can patent it for that usage.

You see this a lot in cancer treatment and it makes a lot of sense. In a proper functioning system (i.e. not the USA±) it's a pretty decent solution.

± Seriously, the system there is designed so all in theory competing components are incentivized to work against consumer interests. Same thing with the housing market pushing house prices (5% interest on 500k is more $ then 5% on 200k, house sellers/older owners think they're rich but only benefit when they sell and downsize; only winners are lenders and real estate investors).

> If they prove, say, that vitamin C stops Alzheimer's then they can patent it for that usage.

Here is an article discussing this approach:

http://stm.sciencemag.org/content/6/248/248fs30

I call them "use patents" but I am not sure if that is an official term or just a colloquialism.

I just asked my wife (who's a pharmacist). She says that it's indeed true that drugs companies basically ignore existing drugs because it's not worth the costs to prove that they work even though they can officially patent them for new usages.

Here's an example: https://en.wikipedia.org/wiki/Pregabalin

That's an epilepsy treatment which also worked for nerve damage. They weren't allowed to dispense the generic for nerve problems. However in practise the prescriptions don't include the reason so in practise they provided the generic.

> The cynic in me says it's because many of them are cheap generics that have little financial upside for large pharmaceuticals.

Social impact bonds are an interesting idea that might help solve this, although I know little about the practicalities. Specifically, a company would pay for the research and trials, and if it's effective, the government (say, the NHS in the UK) would pay a portion of the money saved to the company.

As someone with firsthand experience in this space, it’s hard to get buy-in even in research world for neuroprotective agents. First, this word neuroprotective gets thrown around a lot. Lots of complex efficacy endpoints. Lots of biases about safety. It’s unfortunately tough sledding.

ot: is tough-sledding an autocorrect morphism or a lnown expression?

Not auto-correct. Like saying it’s a hard slog, or a perilous path to take.

It would cost billions to test the various drugs that you mentioned.

No, you are incorrect. It might cost billions to develop them from scratch, but those are already sunk costs. Additional testing and trials do not cost nearly so much. In fact, while they may cost more in some circumstances, the average is only $19 million [0]

That means that even testing the half dozen or so anticonvulsants known to have neuroprotective benefits it would cost in the range of $100 million.

But for the sake of argument, let's grant your premise anyway and see where it leads. Let's say it costs billions, even $20 billion to do the trials. The annual cost of Alzheimers may top $250 billion. So the cost/benefit analysis still works out either way. In fact, in that context the potential savings make the difference between $100 million and $20 billion pretty negligible if the drugs could normalize even a few years for the average patient that would otherwise be plagued with dementia.

[0] https://www.outsourcing-pharma.com/Article/2018/09/26/Clinic...

There's no reason to think valproic acid is going to solve the Alzheimer's problem. It's worked in a couple of mice models but that's it. And we could fill a warehouse with drugs that helped Alzheimer's in microwave and did diddly squat for people.

Just to be clear I think it's worth testing but just not especially more than the 500 other drugs that there is credible reason to think they'd work.

You've put forth a straw man. I haven't claimed a specific drug would solve the problem, only that a class of drugs might help.

Actual trials haven't been done, but anecdotal data from individual case studies show promise. It's absolutely not a silver bullet or potential full cure. It could however be part of a cocktail of drugs that provide significant improvement. Or maybe not. But the incremental cost if studying an already approved drug is negligible compared to creating new drugs from scratch or continuing research on other experimental drugs. But by all means, both kinds of research should occurr.

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