Addressing chronic diseases of the CNS such as Alzheimer’s is clearly a challenging and risky proposition. It is important to ask whether current R & D strategies are the best way to develop new therapies for such conditions. The failure of massive late stage clinical studies such as the bapineuzumab and solanezumab trials are key drivers of the escalating costs of R&D in big pharma. This raises the question of whether novel approaches are needed. Individual company-specific research programs with partially redundant clinical trials may be nearing obsolescence. New approaches that involve a greater degree of cooperation between industry, government and academia may be essential to address the challenges of multi-factorial chronic diseases. While such drug development in the precompetitive space has been much discussed as an alternative strategy, the concept needs further evolution. Clearly a difficulty in the context of Alzheimer’s is the exceedingly lengthy duration of meaningful clinical trials and the lack of surrogate markers. However, pre-competitive collaboration in the early phases of drug R&D may be of value even in this situation.
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