A groundbreaking clinical trial has opened in the UK that could dramatically shorten the wait for effective Alzheimer’s treatments. The AD-SMART study, launched this week, will test multiple drugs simultaneously using a platform design borrowed from cancer research. Its first two candidates are familiar medicines already prescribed for type 2 diabetes and attention deficit hyperactivity disorder: metformin and atomoxetine. For the 600,000 people living with Alzheimer’s in Britain, and the families supporting them, the trial represents a shift from the slow, sequential testing of the past toward a faster, more adaptive model.
Angela Bucksey, 67, from Cambridgeshire, became the first participant to begin treatment. Diagnosed in January, she comes from a family where the disease has already taken her mother and aunts. “It was a disappointment rather than a shock,” she said. “I knew it would restrict my life. But I was determined that it wasn’t going to define me.” Joining the trial, she added, made her feel empowered. “Instead of just sitting there, you’re standing up and saying, I will fight back.”
A platform approach borrowed from oncology
The AD-SMART study is what researchers call a multi-arm, multi-stage platform trial. Unlike traditional studies that test a single drug against placebo over many years, this design evaluates several treatments at once, all measured against a shared control group. If a drug shows no benefit, it can be dropped and replaced without restarting the entire infrastructure. The approach has already transformed research in cancer and motor neurone disease, cutting years from the timeline between laboratory discovery and patient access.
Professor Paresh Malhotra, chief investigator and group leader at the UK Dementia Research Institute Centre for Care Research & Technology at Imperial College London, described the urgency behind the shift. “For too long, Alzheimer’s research has moved at the pace of one drug, one trial, one answer — sometimes taking a decade or more before we know if we’ve found something that works,” he said. “We are applying advances from cancer and other conditions to accelerate testing of treatments for people with Alzheimer’s disease.”
The two initial drugs were selected by an international panel of experts. Metformin, a mainstay of type 2 diabetes treatment, and atomoxetine, used for ADHD, both show potential to reduce brain inflammation — a recognised driver of neurodegeneration. Repurposing existing medicines carries distinct advantages: their safety profiles are well established, manufacturing is already scaled, and they can move straight into late-stage efficacy testing.
Recruitment underway across the UK
The trial aims to enrol 1,200 participants with mild to moderate Alzheimer’s across more than 30 sites. Centres in Cambridgeshire, Surrey, London, Southampton and Edinburgh are already open, with more to follow. Every volunteer will undergo regular cognitive assessments and health checks, allowing researchers to track whether the treatments preserve thinking skills and the ability to carry out everyday activities — outcomes that matter most to patients and carers.
“That’s what patients and their carers care about,” Professor Malhotra emphasised. “Not just biological markers, but whether someone can still make a cup of tea, manage their finances, recognise their grandchildren.”
The first evaluation milestone is expected in 2030. In the meantime, additional treatment arms will likely be added, keeping the pipeline flowing. The trial is led by the UK Dementia Research Institute and Alzheimer’s Research UK, with partnership from the National Institute for Health and Care Research, the Medical Research Council, and Health Data Research UK. Government funding underpins the programme.
Political and personal stakes
Prime Minister Andy Burnham, whose father died from Alzheimer’s last month, spoke at the launch. “I knew how it felt to lose a loved one to dementia, and had seen first-hand the devastating impact of the disease on families,” he said. “That’s why I’m proud to see this trial being launched in the UK, so that cutting-edge treatments can reach patients here as soon as possible.”
For Angela’s husband Steve, who acts as her study partner, the impact is already tangible. “Joining the trial has brought us back from the despair of a diagnosis which everybody recognises is non-recoverable,” he said. “People who know we are on a drug trial understand that we’re doing something about it and, rather than be sorry for us, they can be encouraging.”
Dr Sheona Scales, director of research at Alzheimer’s Research UK, put the broader context plainly: “Time is precious for people living with Alzheimer’s disease and more treatment options are urgently needed.”
Why it Matters
The AD-SMART trial matters because it changes the architecture of hope. For decades, Alzheimer’s research has been defined by high-profile failures and glacial timelines, leaving families with little more than sympathy and palliative care. By adopting a platform model proven in oncology, the UK is not just testing two repurposed drugs — it is building a permanent, adaptable engine for discovery. Every participant enrolled, every arm added, every negative result swiftly discarded, accelerates the day when a diagnosis no longer means an inexorable decline. In a field where time is the cruelest variable, this trial buys something priceless: momentum.
