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Clinical Laboratories and Pathology Groups

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In Vitro Diagnostics Companies Race to Develop Blood-based Tests for Alzheimer’s Disease, Data Suggest a Worldwide Growing Market

As new diagnostic assays are cleared by regulators, clinical laboratories will play a key role in identifying appropriate patients for new less-invasive Alzheimer’s tests

With multiple companies racing to develop a blood-based test for Alzheimer’s disease (AD), clinical laboratories may soon have new less-invasive diagnostic assays for AD on their menus.

Why a race? Because a less-invasive clinical laboratory test that uses a venous blood draw (as opposed to a spinal tap)—and which has increased sensitivity/specificity—has a potentially large market given the substantial numbers of elderly predicted to develop Alzheimer’s over the next decade. It has the potential to be a high volume, high dollar diagnostic test.

In fact, Mordor Intelligence estimates that the market for Alzheimer’s disease therapeutics will grow from $7.7 billion in 2024 to $10.10 billion by 2029.

Alzheimers.gov, an official website of the US government, says, “Researchers have made significant progress in developing, testing, and validating biomarkers that detect signs of the disease process. For example, in addition to PET scans that detect abnormal beta-amyloid plaques and tau tangles [abnormal forms of tau protein] in the brain, NIH-supported scientists have developed the first commercial blood test for Alzheimer’s. This test and others in development can not only help support diagnosis but also be used to screen volunteers for research studies.”

Several test developers presented their research at a recent Alzheimer’s Association   International Conference. They shared data about blood-based assay accuracy in diagnosis of Alzheimer’s as compared to current practices that involve a lumbar puncture (spinal tap) to collect cerebrospinal fluid (CSF).

Additionally, the US Food and Drug Administration (FDA) is clearing new Alzheimer’s drugs for clinical use. The pharma companies behind these drugs need clinical laboratory tests that accurately diagnosis the disease and confirm that it would be appropriate for the patient to receive the new therapeutic drugs, a key element of precision medicine.

“The big promise for blood tests is that they will eventually be accessible, hopefully, cost-effective, and noninvasive,” Rebecca Edelmayer, PhD (above), Vice President, Scientific Engagement, Alzheimer’s Association, told USA Today. “The field is really moving forward with use of these types of tests,” she added. Clinical laboratories may soon have these new assays on their test menus. (Photo copyright: Alzheimer’s Association.)

Companies in the Race to Develop Blood-based Alzheimer’s Tests

One advancing test is the PrecivityAD2 from in vitro test developer C2N Diagnostics, St. Louis, Mo., which Dark Daily reported on in “C2N Diagnostics Releases PrecivityAD, the First Clinical Laboratory Blood Test for Alzheimer’s Disease.”

Researchers found that C2N’s blood test can detect brain amyloid status with “sensitivity, specificity, positive and negative predictive values that approximate those of amyloid positron emission tomography (PET) imaging,” according to a news release.

“The PrecivityAD2 blood test is intended for use in patients aged 55 and older with signs or symptoms of mild cognitive impairment or dementia who are undergoing evaluation of Alzheimer’s disease or dementia. Only a healthcare provider can order the PrecivityAD2 test,” the news release noted.

A study published in Alzheimer’s and Dementia, a journal of the Alzheimer’s Association, used “mass spectrometry-based assays to measure %p-tau217 and amyloid beta 42/40 ratio in blood samples from 583 individuals with suspected AD.”

“The PrecivityAD2 blood test showed strong clinical validity with excellent agreement with brain amyloidosis by PET,” the researchers wrote.

The PrecivityAD2 test, which is mailed directly by C2N to doctors and researchers, is performed at the company’s CLIA-certified lab, according to USA Today, which added that the cost of $1,450 is generally not covered by insurance plans.

Expanding Test Access with IVD Companies

ALZpath, Inc. has a different approach to the Alzheimer’s disease test market. The Carlsbad, Calif.-based company, set up an agreement with in vitro diagnostics (IVD) company Roche Diagnostics for use of its phosphorylated tau (pTau)217 antibody “to develop and commercialize an Alzheimer’s disease diagnostic blood test that will be offered on the Roche Elecsys platform,” according to a news release.

Roche received FDA breakthrough device designation on the Elecsys pTau217 test earlier this year and will work with pharmaceutical company Eli Lilly to commercialize the test.

Estimates show 75% of dementia cases go undetected—a number which could grow to 140 million by 2050, according to data shared by Roche with Fierce Biotech.

“We plan to leverage our installed base of diagnostic systems, which is the largest in the world, to ensure we are able to create access to this test for those who need it the most,” Matt Sause, CEO, Roche Diagnostics, told Fierce Biotech.

Another IVD company, Beckman Coulter, recently signed an agreement to use ALZpath’s pTau217 antibody test in its DxI 9000 Immunoassay Analyzer. In a news release, Kathleen Orland, SVP and General Manager of the Clinical Chemistry Immunoassay Business Unit at Beckman Coulter, said that the test had “high performance in detecting amyloid pathology” and could “integrate into our advanced DxI 9000 platform to support broad-based testing.”

Clinical Laboratory Participation

The FDA is drafting new guidance titled, “Early Alzheimer’s Disease: Developing Drugs for Treatment” that is “intended to assist sponsors in the clinical development of drugs for the treatment of the stages of sporadic Alzheimer’s disease (AD) that occur before the onset of overt dementia.” 

Pharma companies intent on launching new drugs for Alzheimer’s will need medical laboratory tests that accurately diagnosis the disease to confirm the medications would be appropriate for specific patients.

Given development of the aforementioned pTau217 antibody tests, and others featuring different diagnostic technologies, it’s likely clinical laboratories will soon be performing new assays for diagnosing Alzheimer’s disease.

—Donna Marie Pocius

Related Information:

Alzheimer’s Diagnosis and Drugs Market

How New Blood Testing Technology Could Change Alzheimer’s Treatment Forever

New Research Shows the PrecivityAD2 Blood Test Has High Accuracy Compared to Amyloid PET Scans in Individuals with Cognitive Impairment

Clinical Validation of the PrecivityAD2 Blood Test: A Mass Spectrometry-Based Test with Algorithm Combing %p-tau217 and Aβ42/40 Ratio to Identify Presence of Brain Amyloid

ALZpath Announces Licensing Agreement with Roche for Use of ALZpath’s Proprietary

Alzheimer’s Blood Test from Roche, Eli Lilly Nabs FDA Breakthrough Tag

ALZpath Signs Licensing Agreement with Beckman Coulter Diagnostics to Provide Proprietary pTau217 Antibody to Develop a Diagnostic Test for Alzheimer’s Disease

Diagnostic Accuracy of a Plasma Phosphorylated Tau 217 Immunoassay for Alzheimer Disease Pathology

Groundbreaking Alzheimer’s Blood Test Proves Highly Effective in Primary Healthcare

Blood Biomarkers to Detect Alzheimer Disease in Primary Care and Secondary Care

C2N Diagnostics Releases PrecivityAD, the First Clinical Laboratory Blood Test for Alzheimer’s Disease

Big Pharma Ready to Crowd Into the Laboratory Testing Marketplace

Whether laboratory medicine is ready or not, Big Pharma is ready to crowd its way into the laboratory testing marketplace. The world’s largest pharmaceutical companies are recognizing that the success of their prescription drugs will increasingly depend on a clinically-useful companion diagnostic test. Since pharma companies like control over their products, Dark Daily predicts that deals between pharma companies and in vitro diagnostics (IVD) firms will soon be announced.

As this happens, laboratory medicine is likely to be influenced and transformed in ways that will be difficult for pathologists to control and influence. That’s because Big Pharma has tens of billions of dollars to invest in research, clinical trials, and development of products that support the introduction and clinical acceptance of new therapeutic drugs.

This development is directly linked to advances in genetics and molecular diagnostics. Researchers are identifying populations of patients with genetic attributes that either make them prime candidates to respond to a therapeutic drug or a lead pipe cinch to get no therapeutic benefit and even negative side affects. As this occurs for specific cancers and diseases, pharmaceutical firms are recognizing that, for their new drugs to accepted by clinicians and payers, it will need to have a companion diagnostic lab test that affirms that the patient will benefit. Of course, the most recognized example of a companion diagnostic is when the breast cancer patient is tested for the HER2neu mutation. Only if the patient is positive for HER2neu is she a candidate for the drug Herceptin.

Evidence of Big Pharma’s pending move into in vitro diagnostics comes from public statements at various scientific meetings and investor conferences. For example, last month, at the annual meeting of the Society of Clinical Oncology (SCO) in Chicago, discussion of promising new drugs in development invariably included mention of how bio-markers for companion diagnostics were part of the drug development and clinical trial process. Reporters Ron Winslow and Marilyn Chase of The Wall Street Journal covered this meeting, and wrote that research presented at SCO “highlights an important shift in cancer treatment and in attitudes of pharmaceutical and biotechnology companies toward ‘personalized medicine,’ in which treatment is tailored to an individual based on his or her genetic makeup. Companies are beginning to accept a smaller market for some medicines in return for a better chance that those who use them will have a good result.”

The key point to emphasize here is that Big Pharma has the potential to radically transform laboratory medicine as we know it today. Armed with the cash flow from $200 billion in prescription drug sales in the United States alone, Big Pharma has the clout, both financially and politically, to pursue its agenda with vigor.

Further, it should not be overlooked that imaging giants Siemens (NYSE: SI) and General Electric (NYSE:GE) are actively staking out their presence in the in vitro diagnostics sector. In the past 24 months, Siemens invested more than $14 billion to become the world’s second largest IVD manufacturer. On the pharma side, earlier this year, drug and IVD giant Roche Holdings AG (VTX:ROG.VX) invested $3 billion to acquire Ventana Medical Systems, Inc. and its $300 million in annual revenue.

Should the considerable activity of the imaging companies to enter the laboratory testing marketplace be matched by equal or greater activity from Big Pharma, then the traditional profession of laboratory medicine as we know it today is likely to undergo a far-reaching transformation. Lots of money generally implies lots of influence. If pathologists have been worried about how Siemens and GE, with their imaging revenues anchored in radiology, might change the collegial specialty of pathology, then think what can happen as Big Pharma starts pouring some of its billions into in vitro diagnostics with the goal of controlling bio-markers and pointing research into directions that serve their corporate objectives.

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