Commentary
Video
Nilufer Ertekin-Taner contrasts current one-size-fits-all Alzheimer disease treatments with the promise of precision medicine and emphasizes the vital role of collaborative, multidisciplinary care.
In an interview with Pharmacy Times®, Nilufer Ertekin-Taner, MD, PhD, FAAN, a member of the department of neurology at Mayo Clinic, discusses her plenary session "A Roadmap to Precision Medicine in Neurodegenerative Diseases," which she presented at the American Academy of Neurology 2025 Annual Meeting, taking place from April 5 to April 9 in San Diego, California.
Ertekin-Taner explains that current Alzheimer disease (AD) treatments largely focus on symptomatic relief and fail to address the underlying biological diversity among patients. She envisions a future where patients are biologically classified by disease subtype and stage, with therapies tailored accordingly to maximize benefit and minimize risk. Recognizing Alzheimer’s as a chronic, evolving condition, she stresses that treatment plans must adapt over time. Ertekin-Taner also highlights the critical role of pharmacists and care teams in managing complex treatment regimens and drug interactions, especially as multimodal therapies become more prevalent.
Pharmacy Times: How does precision medicine compare with standard approaches to treating neurodegenerative diseases?
1. Standard Alzheimer treatments are uniform and outdated, while precision medicine aims to tailor care based on biology, disease stage, and environmental factors.
2. As treatment strategies grow more complex, multidisciplinary collaboration—especially involving pharmacists—will be essential for optimizing patient care.
3. Advances in understanding disease biology are fueling a hopeful future of targeted therapies that evolve alongside each patient’s disease progression.
Nilufer Ertekin-Taner, MD, PhD: Again, if we take AD as an example, as the most common type of neurodegenerative disease and one that affects tens of millions of individuals, what we have to offer our patients at this time are largely symptomatic treatments that have been around for over a decade. These treatments do not really address the underlying causative factors in this disease, and it is something that we offer essentially every single patient, unless they have contraindications. Despite the fact that each of these patients with AD likely got their disease for their own set of reasons, for their own set of biological reasons, combined with their own set of environmental risk and protective factors, we treat them as though they are identical. Again, more recently, we have the anti-amyloid treatments, and although we are utilizing a little bit of precision medicine principles, as I just explained, in how we counsel our patients, those newly approved treatments address only 1 of the risk pathways of AD, amyloid. That's our current status; either we're treating the patients symptomatically or, for the much smaller number of patients who are getting to be treated with the anti-amyloid treatments, that treatment is geared towards only 1 of the perturbed pathways of AD.
For a future treatment, we envision that this will be a situation where we can actually biologically classify the patient, we can classify the stage at which they are at, and ideally also be able to predict their responses as well as the potential side effects that they may have based on their biology. Furthermore, they should be able to consider their existing environmental factors that may make taking 1 medicine easier than another one. The future will be a combination of all those things so that we can get the highest benefits from these drugs for the patients, that we minimize the side effects, and that we treat the right patient with the right therapy or right set of therapies at the right time. We can also envision that AD and similar neurodegenerative diseases are chronic diseases, and patients progress over a very long period of time. We need to also consider the notion that a set of therapies that may be most useful at an earlier stage may not be very useful at a later stage of the disease. Precision therapies and the notion of precision medicine need to take into account that treatments, treatment strategies, are expected to change along the disease continuum.
Pharmacy Times: What should pharmacists be aware of in the field of precision medicine? How can they collaborate with a patient’s team of providers and specialists to help compliment care?
Nilufer Ertekin-Taner, MD, PhD: Great question, because it gives me the opportunity to emphasize that for us to be able to optimize care of complex patients, like AD patients and others with related neurodegenerative diseases, it's going to take a village. The physicians need to work hand in hand with the pharmacist, hand in hand with other health care providers in the team, hand in hand with the patients, and hand in hand with their care providers and caregivers to be able to provide the optimal treatment to the patients. I think again, to take a page out of the playbook of cancer, we know the importance of that very close teamwork involving the pharmacist and the team, especially as the treatment strategies become more complex. We envision that, much like cancer, the future of diseases like AD with precision therapies is going to involve multiple different types of therapies; maybe these therapies will be administered using different modalities; some might be intravenous, others might be oral. Paying special attention to the potential interactions between these treatment modalities and their interactions with the patient's biology—all of that complexity needs to be managed. Of course, our pharmacist colleagues will play, and are already playing, an immensely important role in the management of patients with AD and other neurodegenerative disorders, but we envision that that's going to continue and most likely will become enhanced as the numbers of treatments get increased. That's what we hope to see as we seek multimodal therapies, both from the standpoint of the types of therapies, the modes of administration, and all of that in the background of the complexity of the disease itself and each patient having different life circumstances, which also need to be taken into the equation as we manage these patients.
Pharmacy Times: Is there anything else you would like to add?
Nilufer Ertekin-Taner, MD, PhD: I would like to leave everybody with a message that I think over the past couple of decades, we have made tremendous progress in understanding the complex biology of neurodegenerative diseases, including AD and related disorders. This increased understanding has led to many, many hundreds of treatment targets that we envision are going to be translated into viable therapies for our patients with these neurodegenerative disorders. My message is one of hope in that we expect that, in the coming decade and decades, we are going to see a significant increase in the types of treatments that we can offer our patients with neurodegenerative diseases, including AD. And that we can hope and expect to practice precision approaches for our patients with these conditions, much like we are doing for cancer. We will continue to work very closely with our colleagues, who are pharmacists, health care providers, and physicians, as well as the patient and their caregivers, to be able to manage these patients in the most optimal fashion possible. I want to thank you for your interest in this topic.
