CPFT enrols first participants in AD-SMART Alzheimer's trial

CPFT enrols first participants

The trust, CPFT, is one of the NHS sites running the national study. The study is testing two Alzheimer's treatments at the same time, with the design allowing more to be added later.

The first two medicines under test are metformin, which doctors widely prescribe for type 2 diabetes, and atomoxetine, which doctors use for attention deficit hyperactivity disorder. Angela and Steve Bucksey, from Cambridgeshire, were among the first to join at the CPFT site. Angela and Steve Bucksey said: "Following Angela's diagnosis, we decided to take part in a study at a local friendly research unit without having to travel into London, and it feels good to be doing something about it." Ben Underwood, CPFT's director of research and development and the trial's local principal investigator, said the trust was "delighted to welcome Angela and Steve". He said the research "would not be possible without people like them coming forward".

Why the design matters

AD-SMART is a multi-arm, multi-stage platform trial. It compares drugs against a shared placebo group, so a higher share of participants receive an active treatment. Drugs that fail can be dropped and replaced without stopping the whole study.

The trial's organizers say the approach has already been used in cancer and motor neurone disease. Underwood said the time to evaluate treatments "can be more than halved, which also cuts costs". Paresh Malhotra, the trial's national chief investigator at Imperial College London and a professor at the UK DRI's Centre for Care Research and Technology, said Alzheimer's research has often followed a pattern of one drug, one trial, one answer over a decade or more.

Whether either drug slows Alzheimer's is the open question.

The drugs and the evidence

AD-SMART's organizers said an international expert panel chose both drugs in consultation with people who have experience of Alzheimer's, based on earlier-stage studies and laboratory research.

The trial's organizers say both drugs may reduce brain inflammation, which is considered one of the drivers of neurodegeneration in Alzheimer's. Both drugs already have approval for other conditions with established safety profiles. That is the point of repurposing: it aims to bypass the lengthy development timeline for new molecules. Participants will have regular health checks and cognitive tests. The trial will assess memory, thinking and day-to-day functioning in people with mild to moderate Alzheimer's. The stated goal is not only to slow symptoms but to preserve quality of life for as long as possible.

Underwood's POPPED platform, which engages patients and the public in dementia research, helped shape the trial design. That includes the measures that define success.

Scale, sites and timeline

The trial aims to recruit 1,200 participants across the UK to test the first two drugs, and the team expects to finish evaluating them in 2030. That target is a small fraction of the roughly 600,000 people in the UK living with Alzheimer's. The team expects up to 20 NHS sites to open over the next 12 to 18 months, with more than 30 planned in total.

The UK DRI and Alzheimer's Research UK lead AD-SMART, in partnership with NIHR, the MRC and Health Data Research UK. Alzheimer's is the most common form of dementia.

What happens next

The trial continues to recruit participants to test the first two drugs and prepare for adding further treatments in later phases. People with a confirmed diagnosis of Alzheimer's can contact the CPFT research team at [email protected] or call 01223 219753.