China enters the aging society ad domain gold mine to be dug

With more than 7% of the population over 65 years old, China has entered an aging society The incidence rate of various kinds of geriatric diseases such as AD will increase greatly China will inevitably face the challenge of aging, and it will be the responsibility of the whole society to let the elderly enjoy their old age Although the proportion of geriatric drugs in China's medical market is still very low, with the realization of universal medical insurance and the improvement of national and social attention to the elderly, the future geriatric drug market will undoubtedly become an area of great growth and vitality Alzheimer's disease (AD) is a degenerative disease of the central nervous system, which is characterized by progressive cognitive impairment and memory impairment It was formerly called Alzheimer's disease, and it is one of the most common senile diseases In most countries, ad is the most common type of dementia, higher than vascular dementia At present, there are about 30 million people with ad in the world, of which the prevalence of ad in the United States was 1.4% in 2006, while the prevalence of ad in the population over 65 years old is 4.8% in China With the aggravation of aging, it is estimated that by 2050, the number of patients in China will be close to 20 million At present, the status of AD drugs market in China is not commensurate with the high incidence rate of AD, mainly because the recognition level of AD is low among domestic doctors and people Although foreign studies have shown that most elderly people have no direct relationship with memory cognition and aging, a large number of people simply believe that dementia is a normal aging process, and low cognition directly leads to AD patients At the same time, low recognition rate is also an important factor hindering the development of AD drug market With the increase of medical treatment rate and diagnosis rate, the domestic ad drug market will have a significant growth in the future It is predicted that AD drug field will become the next "gold mine" to be developed But the existing drug therapy has limited curative effect, and it is difficult to reverse the patient's condition Is it a gold mine or a bubble? It also depends on whether the pharmaceutical industry can develop new drugs with more significant efficacy, which can completely reverse the progressive cognitive impairment and memory loss of patients The rapid development of global market although Alzheimer's disease was named in 1906, but for a long time, there was not a specific drug for the disease For a long time, it seems that only brain cell resurrection drugs such as Naofukang and Ginkgo biloba preparation or antioxidants can be used to alleviate the disease It was not until 1993 that FDA approved the listing of tacrine developed by yanyeyi of Japan, marking the formation of ad professional therapeutic drug market So far, there are 5 drugs approved by FDA in total In addition, there are several ad drugs listed in other countries, including huperzine A, which is independently developed in China Because of the safety, tacrolin failed to attract people's attention after its listing; in 1997, donepezil was listed in the United States, and its sales volume reached US $1.215 billion in 2003, taking the lead in becoming a "heavy bomb" class product Since then, kabaratin and memantine, which were listed on the market, have also made no mistake in sales performance According to the statistics of IMS and related pharmaceutical companies' financial statements, in 2008, all The total sales volume of global ad patent drugs reached 6.229 billion US dollars, an increase of 12.5% over 2007, which is twice the growth rate of the global pharmaceutical market in the same period With the aging of the society, the increasing awareness of ad in developing countries and the coming of new drugs, AD drug market will maintain a growth rate of 10% - 15% It is estimated that the global ad drug market will reach 20 billion US dollars by 2020 According to a recent report by the drug associated press, if the treatment of ad can not make a breakthrough, the number of AD patients in the United States will increase to 20 million in 2020 The treatment of ad is not only a medical problem, but also a social problem that puzzles the whole world At present, the treatment of ad can only be done by early detection and early control, but the low rate of treatment and low recognition rate make most patients miss the best treatment stage when they are diagnosed with the disease The significance of simple control is relatively limited, and reversal can hardly be achieved If the new ad drug in research can break through the limitation of the course of disease, it will bring a huge market for medicine“ Gold " Therefore, we turn our attention to some new ad drugs in the clinical research stage It is expected that new drugs will appear According to pharmaprojects data, there are more than 100 ad drugs in clinical research stage around the world At present, the development of ad drugs mainly focuses on three directions: developing new products with product formulation optimization, screening new products with existing drug mechanism and finding new target Dosage form optimization of existing products The biggest characteristic of ad is forgetfulness It's unrealistic for patients to remember to take medicine many times a day, and it's not convenient for patients' families to pass through Therefore, reducing the times of taking medicine can greatly improve the compliance of medication At present, the three best-selling varieties of ad drugs - donepezil, kabbalatin and memantine have been optimized in dosage form Novartis is approved to market in 2007 Compared with the ordinary carbatron preparation, it only needs to be used once a day, and effectively reduces the digestive tract reaction Forest's memantine sustained-release tablets have entered phase III clinical application, and the number of drug use has been adjusted from twice a day to once a day Donepezil itself only needs once a day, but Weicai company has carried out the clinical trial of long-acting donepezil The clinical trial shows that once a patient takes medicine, it can last for 1-2 weeks The introduction of long-acting agents will bring great convenience to AD patients Screening of new products with existing mechanism of action There are not many drugs targeting at the inhibition of acetylcholinesterase or NMDA receptor in the research Rs-1259 is the first acetylcholinesterase inhibitor developed in Japan At present, phase I clinical trial of ad is being carried out Because the drug has the function of slightly blocking 5-HT reuptake at the same time, the effect is very good for the elderly patients with poor mood Evt-101 is a NMDA receptor blocker developed by Roche company It can improve the main adverse reactions of these drugs In addition, evt-101 has the anti Parkinson effect It is currently in phase I clinical Dimebolin is a new drug of great concern Clinical research has found that the combination of acetylcholinesterase inhibitor and NMDA receptor blocker memantine has synergistic effect, good tolerance and no serious adverse reactions Dimebolin is the first drug that can only block acetylcholinesterase and NMDA receptor at the same time Pfizer spent $725 million in 2008 to obtain the license of the drug Right, has entered stage III clinical Search for new mechanism of action β - amyloid inhibitor is the most concerned research direction At present, there are many such drugs in clinical research Solanezumab, an anti amyloid β monoclonal antibody preparation jointly developed by Lilly and elan, and bapineuzumab, a similar drug jointly developed by Wyeth and elan, have entered phase III clinical practice These drugs can clear the β amyloid accumulated on the surface of the brain and block the effect of the protein on the memory and cognitive function of patients In addition, it can also play the same role by inhibiting secretase It was found that β - secretase and γ - secretase are the rate limiting enzymes of β - amyloid protein, which is the substance of senile plaques Therefore, secretase inhibitors may have the potential to reverse the symptoms of AD As a representative product of this kind of drugs, cts-21166, a β - secretase inhibitor of comentis in the United States, has been transferred to Japan's Astaire company with a price of up to $760 million only after entering phase I clinical practice Semagacestat (ly-450139), a γ - secretase inhibitor jointly developed by Lilly and Ilan, will complete phase III clinical trials in 2012 Oxidative free radicals are believed to be involved in the death process of AD brain cells They cause β - amyloid protein deposition and react with cell membrane, leading to intracellular oxidation process and free radical release Clinical trials in North America have shown that EGb-761, a free radical scavenger, has a clear effect on improving cognitive function of AD patients, which is better than tacrolin EGb-761 is a kind of Ginkgo biloba extract, which is in phase III clinical Tau protein is another in-depth direction of AD research at present It is believed that the tangle of nerve fibers in nerve cells is the core factor for the formation of senile plaques, and it is precisely the abnormal phosphorylation and glycosylation of tau protein that causes the tangle of nerve fibers At present, most of these drugs are still in the preclinical research stage, among which np-12 is an ad drug developed by a Spanish company, which has entered the second stage of clinical practice The drug is through GSK3 to affect the over phosphorylation of tau protein, so as to eliminate age spots Because ad is a disease with uncertain mechanism, there is no definite route for new drug research In addition to the above mechanisms, there are also some drugs that act on dopamine receptor, amda receptor, GABA receptor, 5-HT receptor, nicotine receptor and so on We believe that these new mechanisms will inevitably lead to the emergence of drugs that can reverse the disease, which will bring huge economic and social benefits.