Abbott Targets Adult ADHD with Nicotinic Drug, Shows Strong CNS Pipeline

Implications: Abbott’s Neuronal Nicotinic Receptor (NNR) partial agonist platform is an innovative target for ADHD and potentially other CNS disorders.  The Phase II data on ABT-089 suggests efficacy for adult ADHD with good safety/tolerability.  NNRs will not have the kind of effect size seen with stimulants but there is certainly a clinical need for drugs that work differently than current treatments including Eli Lilly’s Strattera, a norepinephrine reuptake inhibitor.  I attended the APA annual meeting in Washington DC and was impressed by Abbott’s neuroscience pipeline aiming at novel treatments for Alzheimer’s Disease, ADHD, and schizophrenia - beyond just the NNRs.

Analysis: Adult ADHD represents a potentially large treatment population, with an estimated prevalence of 4-5% of adults and numbers in the range of 5-10+ million individuals depending on the age range one looks at.  Recent studies suggest only 1 in 5 adults that meet criteria for ADHD actually receive medication treatment for it.  Stimulants are highly effective for adult ADHD but may carry certain medical risks in a subset of patients on account of the cardiovascular effects, in addition to ‘perception’ issues for patients and clinicians alike.   Atomoxetine (Strattera; Eli Lilly) is the only non-scheduled FDA-approved treatment for adult ADHD and other off-label choices (Provigil, tricyclic antidepressants, alpha-2 agonists) carry only modest benefit, if much at all in adults.   The ADHD market will likely see one or two alpha-agonists for child/adolescent ADHD in the next year or two, though hypotension and efficacy may be limitations in adults.  The profile of NNRs, especially with its seeming lack of cardiovascular side effects and potential value on executive function/inattention, is attractive for adult ADHD and possibly other disorders (ie, cognitive impairment in schizophrenia, depression). We will need to await larger trials that will bear out efficacy in clearer terms but this is a positive development.