Neuropeptides: ACTH-peptides in dementia

Studies on the treatment of demented patients with ACTH neuropeptides are reviewed. The discussion is restricted to ACTH4-10 and an orally active peptide, the modified ACTH4-9 fragment: H-Met (O2)-Glu-His-Phe-D-Lys-Phe-O (Org 2766). The first part of the review concentrates on data from animal pharmacology and basic and human studies which have relevance for the clinical effects shown in demented patients. The second part concerns clinical studies in man. Own results from a placebo-controlled dose finding study on the treatment of 156 PDSD patients with Org 2766 are presented. Org 2766 was in this study found to have a significant therapeutic effect in patients with PDSD measured mainly on the basis of SCAG total, although the effect was found to be rather small (average 4 points improvement on SCAG total). Post hoc analyses demonstrated that effects were clinically relevant for only 25 per cent of the patients. Analyses of SCAG factor scores indicated an effect on cognitive function and somatic function. The study failed to show clear dose-response relationship. However, before a final conclusion on the efficacy of Org 2766 can be reached the results must be confirmed by others.