According to CBDMT, the market and business intelligence company, the Alzheimer\'s disease (AD) market was valued at $5.5 billion in 2009. The AD market is led by North America with a market share of 52% accounting for sales of $2.8 billion. The Alzheimer disease market could account for more than $10.1 billion by 2020.

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Alzheimer’s Disease (AD) Report
Authors: Emilie Hilpert, Philippe Tramoy
Date: 01 June 2010
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Table of Contents
1 Global information .......................................................................................................................... 5
1.1 History ..................................................................................................................................... 5
1.2 Presentation of the disease..................................................................................................... 5
1.3 Patients with Alzheimer’s disease forecast............................................................................. 5
1.4 Prevalence ............................................................................................................................... 7
2 Alzheimer’s disease......................................................................................................................... 7
2.1 Symptoms................................................................................................................................ 7
2.2 Physiopathology ...................................................................................................................... 9
2.3 Risk factors ............................................................................................................................ 12
Age................................................................................................................................................. 12
Sex ................................................................................................................................................. 12
Genetic affects............................................................................................................................... 12
2.4 Alzheimer’s disease as a genetic disease .............................................................................. 13
2.5 Diagnosis................................................................................................................................ 13
3 Market........................................................................................................................................... 15
3.1 Overview................................................................................................................................ 15
3.2 Treatments and products...................................................................................................... 16
Acetylcholinesterase inhibitors..................................................................................................... 21
NMDA receptor antagonist ........................................................................................................... 23
3.3 Market previsions.................................................................................................................. 23
4 Products in development .............................................................................................................. 25
4.1 Overview................................................................................................................................ 25
4.2 Products in phase III .............................................................................................................. 26
Bapineuzumab............................................................................................................................... 28
Dimebon........................................................................................................................................ 30
EGb-761......................................................................................................................................... 35
Immune Globulin Intravenous....................................................................................................... 36
Leuprolide acetate implant ........................................................................................................... 37

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LY-450139...................................................................................................................................... 38
Neramexane .................................................................................................................................. 39
4.3 Products in phase II ............................................................................................................... 40
5 Pipeline of drugs for Alzheimer’s disease, Discovery to Phase II .................................................. 42
5.1 Drugs in phase II .................................................................................................................... 42
5.2 Drugs in phase I ..................................................................................................................... 45
5.3 Drugs in preclinical phase...................................................................................................... 48
5.4 Drugs in discovery phase....................................................................................................... 50
6 Company profiles .......................................................................................................................... 55
6.1 Baxter International Inc......................................................................................................... 55
6.2 Bellus Health Inc.................................................................................................................... 57
6.3 Eisai Co Ltd............................................................................................................................. 58
6.4 Elan Corp Plc.......................................................................................................................... 59
6.5 Eli Lilly and Co........................................................................................................................ 61
6.6 Forest laboratories Inc........................................................................................................... 63
6.7 Johnson & Johnson................................................................................................................ 64
6.8 Merz pharmaceutical............................................................................................................. 66
6.9 Novartis Ag ............................................................................................................................ 67
6.10 Pfizer Inc................................................................................................................................ 69
List of Figures
Figure 1: Estimated evolution of people with Alzheimer’s disease 2010 to 2050 (in millions) by
geographical zones.................................................................................................................................. 6
Figure 2: Progression of Alzheimer's disease (black dots) ...................................................................... 9
Figure 3: Diagram of physiopathology mechanisms ............................................................................. 11
Figure 4: Sales repartition by types of drugs......................................................................................... 15
Figure 5: Sales repartition by geographical zones................................................................................. 15
Figure 6: Sales repartition by pharmaceutical companies .................................................................... 16
Figure 7: Therapeutic ways to treat Alzheimer's disease...................................................................... 17
Figure 8: Sales of marketed drugs by therapeutic classes .................................................................... 19
Figure 9: Sales distribution of Aricept in 2009 ...................................................................................... 22
Figure 10: Estimated evolution of sales for Alzheimer's disease drugs for 2009 to 2020 .................... 23
Figure 11: Repartion of Alzheimer's drugs turnover for 2009 to 2020................................................. 24

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Figure 12: Pipeline drugs in development in 2010................................................................................ 25
Figure 13: Clinical trials by development phases .................................................................................. 26
Figure 14: Drugs in phase III by therapeutic classes.............................................................................. 26
Figure 15: Drugs in phase II by therapeutic classes............................................................................... 40
Figure 16: Repartition of symptomatic treatments by mechanisms of action ..................................... 41
Figure 17: Repartition of curative treatments by mechanisms of action ............................................. 41
List of Tables
Table 1: Total population over 65, estimated number of people with Alzheimer’s disease from 2010
to 2020 (in millions) by geographical zones............................................................................................ 6
Table 2: Incidence and prevalence on population aged 65 and over in 2010, 2015 and 2020 by
geographical zones.................................................................................................................................. 7
Table 3: Main warning signs of Alzheimer's disease............................................................................... 7
Table 4: Common clinical features in Alzheimer’s disease ..................................................................... 8
Table 5: Potential risks and protective factors for Alzheimer’s disease ............................................... 12
Table 6: Differences between genetic disease and genetic susceptibility4
........................................... 13
Table 7: Main brand-name drugs sold in the world.............................................................................. 18
Table 8: Alzheimer's degree of severity treated by marketed drugs.................................................... 19
Table 9: Current drug treatments for Alzheimer's disease ................................................................... 20
Table 10: Sales and forecast of main acetylcholinesterase inhibitor drugs.......................................... 21
Table 11: Sales and forecast of main NMDA receptor antagonist drugs .............................................. 23
Table 12: Drugs in phase III ................................................................................................................... 26
Table 13: Alzheimer's degree of severity treated by drugs in phase III ................................................ 27
Table 14: Clinical trials of Bapineuzumab ............................................................................................. 29
Table 15: Clinical trials of Dimebon....................................................................................................... 32
Table 16: Clinical trials of EGb-761........................................................................................................ 35
Table 17: Clinical trials of Gammagard (Immune Globulin Intravenous).............................................. 36
Table 18: Clinical trials of Memryte (leuprolide acetate implant) ........................................................ 37
Table 19: Clinical trials of LY-450139..................................................................................................... 38
Table 20: Clinical trials of Neramexane................................................................................................. 40

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1 Global information
Alzheimer’s disease is a neurological disorder affecting the central nervous system (CNS) that leads to
a progressive loss of memory, language, and the ability to recognize friends and family. The average
course of the disease, from early symptoms to complete loss of cognitive ability, is 10 years.
1.1 History
In 1906, at a psychiatry meeting, the German psychiatrist Alois Alzheimer (1864-1915) presented the
Auguste’s case, a patient whom he examined a few years before. Auguste D. was a 51-year-old
woman, who was suffering from disorientation, aphasia, auditory hallucinations, paranoia,
unpredictable behavior and pronounced psycho-social impairment. Alois Alzheimer described
organic changes in her brain, like plaques, tangles and arteriosclerosis. This finding formed his
hypothesis of her dementia having an organic cause. Even if History has retained Alzheimer’s name
for talking about this kind of dementia, his description was not a new discovery. The association
between plaques and dementia had been reported in 1887 for the first time by S. Beljahow.
1.2 Presentation of the disease
Alzheimer’s disease (AD) is by far the most common cause of dementia1
associated with aging; it
accounts for more than 60% of all dementia. Alzheimer’s disease is characterized by an insidious
onset and slow deterioration in cognition, functional ability (e.g., activities of daily living), behavior,
and mood. In USA, AD is the 7th
leading cause of mortality.
In 2010, more of 21 million people will be affected by this disease in the world. As the world
population ages, this number will increase.
1.3 Patients with Alzheimer’s disease forecast
Today, more than 20.8 million people are affected by Alzheimer’s disease around the world. The
Alzheimer’s disease patient population will grow over the next 10 years. As the ‘baby boomer’
generation ages in developed countries, the percentage of the population aged 65 and over will
increase to reach 716.4 million by 2020. The Alzheimer’s disease patient population is forecast to be
up to 31.3 million by 2020. Estimations predict nearly a doubling of patients every 20 years.
The Alzheimer’s disease population in Asia is projected to grow at the highest rate to reach 15 million
accounting for nearly half of AD patients by 2020.
1
Dementia is a syndrome due to disease of the brain, usually chronic, characterized by a progressive, global deterioration in
intellect including memory, learning, orientation, language, comprehension and judgment.