Commenting on Recent Research News

Rapid Response to Alzheimer’s Disease News for the Penn Memory Center Community - January 2008

By Steven E. Arnold, M.D.

Perispinal Etanercept Treatments for Alzheimer’s Disease

We’ve been receiving many calls inquiring about a newly published case report in the Journal of Neuroinflammation describing a novel treatment for Alzheimer’s disease. The authors described their experience injecting a powerful anti-inflammatory medicine around the spinal cord in the neck and then turning the patient upside down briefly to promote diffusion of the drug towards the brain. The medicine is called etanercept (Enbrel) and is currently approved for use in rheumatoid arthritis, psoriasis, and other autoimmune disorders. The authors of the case report describe immediate and sustained symptomatic improvement with weekly treatments. The patient was more alert, more attentive, calmer, his language improved, and his thinking was clearer. Memory impairment, the cardinal feature of Alzheimer’s disease, did not notably improve using a standard test of remembering a brief list of words.

Scientifically, this anecdote is of interest to us because it represents an initial test of a novel anti-inflammatory drug and a novel way to administer a drug that otherwise is not able to get into the brain. Clinically however, it is just an anecdote. The authors say they have used this treatment in other patients with success, but compelling evidence has not been provided, let alone a placebo-controlled clinical trial that is the gold-standard method to demonstrate the benefit of a new medicine. Furthermore, the potential complications and side effects of such invasive treatments are not well described.

We are aggressive in evaluating and using any beneficial treatment for cognitive impairments, but are rigorous in our evaluations. At this point, we do not feel perispinal etanercept treatment has enough evidence to widely recommend it.

Steven E. Arnold, M.D.
Professor of Psychiatry and Neurology
Director, Penn Memory Center
Director, Geriatric Psychiatry Section
Associate Director, Institute on Aging
Ralston House
3615 Chestnut Street
Philadelphia, PA 19104-340