New downtown Spokane clinic offers cutting-edge Alzheimer's treatments and research

Dec. 12—A Spokane neurologist has opened a downtown clinic focused on new treatments and research in the fight against Alzheimer's disease.

Dr. David Greeley bought the former Global Credit Union building at 1520 W. Third Ave., to house his independent practice, Northwest Neurological, and separate research company, Kingfisher Cooperative.

The practice does treat other conditions, such as Parkinson's disease, depression and migraines, but Greeley said it's the Spokane region's only site administering recent Food and Drug Administration-approved infusions for Alzheimer's. Those include Leqembi, fully approved in July, and Aduhelm, which is in follow-up trials with FDA accelerated approval.

Providence and MultiCare health systems in Spokane confirmed their providers aren't currently offering Leqembi or Aduhelm. The latest treatments differ in that they go after the underlying biology of the disease process with the aim of slowing the decline of memory, thinking and function, according to the Alzheimer's Association.

"We're doing the first, at least in this area, for Alzheimer's disease treatment," Greeley said about the disease-modifying drugs. "This is really the first treatment for Alzheimer's that's significant. There are two, with a third one coming on. We were part of trials for all of those."

For about 30 years, Alzheimer's drugs that might temporarily ease some symptoms have been available.

Kingfisher is participating in three Alzheimer's drug trials. More are planned.

"That's our primary focus, studying the next best thing, because what just got FDA approved is helpful, but it's not really a cure," Greeley said.

"We'll be able to do a blood test I think in a year or two, for Alzheimer's or MCI (mild cognitive impairment) diagnosis. We'll be able to tell people they have Alzheimer's disease before they know it."

The monoclonal antibody infusions that include Leqembi are designed to remove a substance called beta-amyloid from the brain that forms sticky plaques, a hallmark in Alzheimer's. But they have limitations and risks, such as brain bleeding in about 10% to 40% of patients, depending on the drug, Greeley said. Patients must be screened.

The third drug being studied and expected soon, Donanemab, also shows promise in slowing disease progression, said Alexis Bonoff, Alzheimer's Association Washington state chapter community outreach manager.

"Donanemab is currently in FDA review," Bonoff said. "This one has had the best results in the clinical trial, so we're excited about it."

She agreed recent advancements are ushering in a new era.

"We have over 1,000 projects in 53 countries, so that means that at any moment, any time, somebody is working on trying to find a better treatment and hopefully a full cure," Bonoff said. "I'd say we really are in the era of new treatment and discovery. We're going to see new things happening tomorrow, next week, next month."

Northwest Neurological has a new infusion suite, where patients can get Leqembi intravenous treatments once every two weeks. Only about 8% to 10% qualify for that drug, Greeley said. When it works, benefits are real. Calling it rare, Greeley said one of his patients on Leqembi went from a third-grade level mental decline back to normal cognitive function for a return to work.

Under FDA approval, Medicare Part B could pay 80% of Leqembi's cost, which is about $26,500 a year. Other costs may not be covered. PET scans, often used for diagnosis, can cost $7,000, Greeley said. Recent Medicare decisions might cover a portion of that by next year. To identify potential side effects, four MRIs a year also are required.

Other options may soon gain approval.

Greeley is working with a South Korean company, AriBio, on a pill called AR1001 that he said shows promise in Alzheimer's studies. He is AriBio's chief medical officer. A U.S. multicenter Phase 3 trial is underway, and an overseas one is starting.

At Kingfisher, a physician's associate is the primary investigator for AR1001 studies.

"It's a drug like Viagra that increases blood flow to the brain, actually," Greeley said. "It's commercially available in Korea for erectile dysfunction at bigger doses. We're only studying 30 milligrams, so it's very safe.

"It sounds simple, but increasing blood flow to any organ almost always helps. That is what's happening a lot with Alzheimer's — with getting older — just like our skin, muscles, everything doesn't get the blood flow it used to get, all of a sudden you start pumping more blood into the brain, it just does better. That's what we need to prove."

The class of drug is used for lung disease and even premature babies for increasing blood flow, he added.

"We're hoping if the trial is successful, we can then present the data to the FDA and get it approved, but that's two to three years from now."

About six years ago, Greeley had patients begin an Aduhelm trial for once-a-month infusions. The FDA said the drug proved effective but required a post-approval trial to verify clinical benefit, which is nearly complete, Greeley said.

Among about 25 people who were on Aduhelm locally, 15 are still his patients.

"For all but one of those 15, their amyloid markers normalized," he said, referring to the protein deposits that characterize the disease. He added that Aduhelm will continue to be researched.

Greeley said he's also in talks to do first-phase Alzheimer's trials at Washington State University's Sleep Lab in Spokane, known for its work-related sleep deprivation research. Collaborative work would allow Alzheimer's patients to stay overnight for 24-hour monitoring. The lab is testing its device that can measure cerebral blood flow in real time, an ideal tool for studying the Korean drug, he said.

In the downtown building, Greeley hopes to attract other physicians, a pharmacist and a physical therapy group. He is hoping a nonprofit foundation can oversee seminars and social worker services to help neurology patients, such as those planning to remain home.

"One of the biggest missing links in Alzheimer's and Parkinson's is end-of-life care," he said. "There are great palliative and hospice care centers in town, but they don't always accept somebody with dementia as a diagnosis because I can't say they have less than six months to live. Some can live 10 years, but they still need help."

Greeley first joined Rockwood Clinic in 1992. In 1999, he began Northwest Neurological.

Greeley thinks future Alzheimer's treatments are likely to be similar to cancer treatment now.

"Just like chemotherapy is usually one, two or three drugs to beat a cancer, I think down the road it's going to take one, two or three drugs to really beat Alzheimer's disease."