Axona videos

Mechanism of action


Diminished cerebral glucose metabolism in Alzheimer's disease1,2

Find out more about one of the earliest brain changes that occurs in Alzheimer's disease.

 

Ketones bodies: the brain's natural back-up fuel3,4

Find out how Axona can help during times of diminished cerebral glucose metabolism.

 

Common questions


Introduction and objectives

Dr. Martin Farlow
Professor of Neurology, Vice-Chair of Research, Indiana University School of Medicine; Co-Director of the Indiana Alzheimer's Disease Center

 

Why is ketosis important in Alzheimer's disease?

Dr. Richard Isaacson
Associate Professor of Neurology (Education), and Director of the Alzheimer’s Prevention & Treatment Program at Weill Cornell Medical College/New York-Presbyterian Hospital

Patients with Alzheimer’s disease become less and less responsive to glucose as a primary source of energy for the brain. Instead, they can use an alternative fuel source called ketone bodies. PET scans show clearly that there is a decreased amount of red color, depicting diminished cerebral glucose metabolism. Ketone bodies can actually provide up to two-thirds of the usual energy requirements for the brain. This is actually a naturally occurring substance the body can produce on its own during starvation.

 

How can I get my patients off to a good start using Axona?

Dr. Mary Quiceno
Assistant Professor of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center

When patients first start on Axona, their gut isn’t used to digesting the key ingredients, which are medium-chain triglycerides, or MCTs. Even after some time, digesting these can be hard. If patients carefully follow dosage instructions when they first start Axona, they’re more likely to stay with Axona and have a good long-term outcome. We strongly recommend that all patients begin to use Axona according to a Graduated Dosing Plan. Patients begin at a low dose and gradually increase to the full dose in a strategy known as "start low and go slow." The starting dose is 10 g. After 2 days, the patients increase that dose by another 10 g. After 2 more days, the dose is increased by an additional 10 g. After a week has passed, the patient is up to a full dose of 40 g. We also recommend that patients take Axona after a full meal, preferably one that includes proteins and fat. Patients should try to take it after breakfast or after lunch, so it will be active in their system during the day while they’re awake.

Adverse events were common in the Axona trial, whether or not patients used Axona. This is because the patients enrolled were elderly, and 80% were on one or more other Alzheimer’s disease medications, which also had gastrointestinal adverse events.

Overall, 76% of patients taking Axona had an adverse event, whereas 62% of patients taking placebo also had an adverse event. The most common adverse event was diarrhea, which affected 24% of patients taking Axona, but also 14% of patients taking placebo. Flatulence occurred in 17% of patients taking Axona, but 8% of patients on placebo. So in this population of patients with a fairly high level of gastrointestinal upset overall, Axona did not substantially worsen gastrointestinal problems. The good news is that as physicians become more familiar with how to use Axona, the number of problems declines. When Axona is used carefully, the number of new adverse events decreases over time. At first, when physicians were unfamiliar with how to us Axona, patients reported various adverse events, mostly related to gastrointestinal distress. The rate of adverse events was never high, even at first. Fewer than 2% of patients reported adverse events, yet as physicians became familiar with Axona, they were able to give their patients better advice so that the rate of adverse events per month decreased to fewer than one event for every 250 patients.

 

How can you tell if Axona is working?

Dr. Marc Agronin
Director of Mental Health and Clinical Research, Miami Jewish Health Systems

As a clinician you make certain that you have a good baseline assessment of the patient before starting him or her on Axona. You also have some way of tracking the patient over time, whether it’s your clinical skills, or using some form of a clinical instrument. Also, encourage the caregiver to become involved. A caregiver plays a critical role not only in terms of knowing how to dose and titrate medication over time, but also giving you input into how the patient is doing over time

 

How quickly should you expect to see results with Axona?

Dr. Marc Agronin
Director of Mental Health and Clinical Research, Miami Jewish Health Systems

This is a crucial question, and it’s important to note that you’re not going to see a change overnight – it takes time. We recommend that you wait about 90 days based on the clinical trials to really see that significant change. There might be change sooner than that, but we don’t have any data that suggest that we know the exact rate at which this is going to happen or the exact degree to which this will take place.

The role of the caregiver is critically important not only in terms of initiating and maintaining Axona treatment over time, but also in terms of monitoring the course of the patient. The Axona representatives have great resources in terms of a tips sheet, which can help educate caregivers on how best to both dose and titrate Axona over time. There’s a brochure that discusses what Axona does and Alzheimer’s disease in general. In clinical trials, individuals who were APOE4(-) and more adherent to Axona over time did better in terms of their cognitive skills. This really speaks to the importance of the caregiver being educated in how to manage Axona treatment. We know in general that individuals suffering from Alzheimer’s disease do better when caregivers are more involved.

 

Summary of key points

Dr. Martin Farlow, Dr. Richard Isaacson, Dr. Mary Quiceno, and Dr. Marc Agronin

 

Tolerability


Describe a typical patient

Dr. Ira Goodman
Associate Professor of Neurology, University of Central Florida; Director of Neurosciences Compass Clinic

Dr. Richard Isaacson
Associate Professor of Neurology (Education), and Director of the Alzheimer’s Prevention & Treatment Program at Weill Cornell Medical College/New York-Presbyterian Hospital

 

How should patients use Axona?

Dr. Ira Goodman
Associate Professor of Neurology, University of Central Florida; Director of Neurosciences Compass Clinic

Dr. Richard Isaacson
Associate Professor of Neurology (Education), and Director of the Alzheimer’s Prevention & Treatment Program at Weill Cornell Medical College/New York-Presbyterian Hospital

 

How do you incorporate Axona into your practice?

Dr. Ira Goodman
Associate Professor of Neurology, University of Central Florida; Director of Neurosciences Compass Clinic

Dr. Richard Isaacson
Associate Professor of Neurology (Education), and Director of the Alzheimer’s Prevention & Treatment Program at Weill Cornell Medical College/New York-Presbyterian Hospital

 

Axona package


Axona Patient Starter Kit

The Axona Patient Starter Kit provides everything needed for the first week of Axona.

 

Axona 30-day package

The Axona 30-day package contains everything needed for 1 month of Axona.

 

How to use Axona


How to prepare Axona

Simple instructions for preparing Axona with liquids or soft foods for your loved one.

 

Titrating with the Axona Patient Starter Kit

The Axona 7-Day Patient Starter Kit is specially designed to make graduated dosing easy to help your loved one start off right.

 

Titrating with the Axona 30-day package

The Axona 30-day package makes graduated dosing easy with just a measuring spoon to help your loved one start off right and stay on track.