Two medicines millions of Britons already know — one taken daily for type 2 diabetes, the other for ADHD — are about to be put to an entirely new test. The AD-SMART trial, a national Alzheimer’s trial, launched in the UK this week, and it will investigate whether metformin and atomoxetine can slow or ease the symptoms of Alzheimer’s disease.
The launch, on 22 October 2026, is being described as a landmark moment for British dementia research. Not just because of the drugs chosen, but because of the way they will be tested. AD-SMART is the first UK trial to combine an adaptive multi-arm “platform” design with the systematic testing of repurposed medicines in people living with Alzheimer’s.
It is led by the UK Dementia Research Institute and Alzheimer’s Research UK, in partnership with the National Institute for Health and Care Research, the Medical Research Council and Health Data Research UK, with funding committed by the UK government.
For families living with Alzheimer’s, the promise is not a miracle cure. It is something the field has arguably needed just as much: a faster, smarter way of finding out which drugs actually work.
What makes this Alzheimer’s trial different
In a traditional drug trial, one medicine is compared against a placebo, and it can take a decade or more to get an answer. One drug, one trial, one enormous bill — and if the drug fails, researchers go back to the beginning and start again with the next candidate. AD-SMART does something more ambitious.
Several treatments are tested at the same time, inside one permanent trial structure. The trial is designed to keep running for years, with drugs entering and leaving as the evidence develops, rather than ending when a single medicine has been judged.
One shared placebo group
Every drug in the trial is compared against a single shared placebo group, rather than each medicine needing a placebo group of its own. That matters more than it might sound. Because the placebo group is shared, a larger proportion of participants receive an active treatment than they would in a conventional trial — something that matters a great deal to volunteers who are giving their time while living with a progressive disease.
It also makes the science cleaner. Each drug is measured against the same group of people, recruited in the same way and followed over the same period, so the results are easier to compare with one another.
Fail fast, then move on
Results are checked at regular stages along the way, in what researchers call interim analyses. Any drug that is not showing benefit can be dropped early, and a new one brought in to take its place — so fewer people spend time on treatments that do not work, and effort concentrates on the promising ones.
The trial’s organisers say the design could more than halve the time it takes to find out whether a drug works. In a field where answers have traditionally arrived one decade at a time, that is a fundamental change of pace.
The MND-SMART trial proved the model
It is not an untested idea. MND-SMART, a similar platform trial for motor neurone disease also led by the UK Dementia Research Institute, concluded that its first drugs were ineffective in just over three years — a process that would normally have taken at least eight. That trial has since moved on to testing other drugs, without needing to be rebuilt from scratch.
“We already know this model works,” said Professor Siddharthan Chandran, Director of the UK Dementia Research Institute. “Now, we’re doing the same for Alzheimer’s.”
The approach borrows from cancer research, where platform trials have been used for years to test multiple treatments against a shared standard of care. AD-SMART applies the same logic to Alzheimer’s for the first time in the UK.
Why diabetes and ADHD drugs?
Metformin and atomoxetine were not developed for Alzheimer’s — and that is precisely the point. Both were chosen by an international panel of experts working alongside people with lived experience of Alzheimer’s, based on evidence from earlier patient studies and laboratory research.
Metformin: the diabetes medicine
Metformin is one of the most widely prescribed drugs in Britain, used to treat type 2 diabetes. It has been taken by millions of people over many years, which means doctors already know a great deal about its safety and its side effects. If you want to understand the condition it was designed for, FamePost’s guide to diabetes symptoms and warning signs explains the condition in plain English.
Researchers have long been interested in the overlap between type 2 diabetes and dementia, and in whether a drug that helps the body handle sugar and energy might also influence what happens in the brain. Earlier studies gave the panel enough reason to put metformin to a proper test.
Atomoxetine: the ADHD medicine
Atomoxetine is used to treat attention deficit hyperactivity disorder. Like metformin, it is an established medicine with a well-understood safety record, taken every day by large numbers of people.
The reason both drugs made the cut is brain inflammation: both medicines show potential to reduce it, and inflammation is a driver of the neurodegeneration behind Alzheimer’s. The panel weighed the earlier evidence for each candidate and selected the two drugs it judged most likely to make a difference to memory, thinking and day-to-day life.
Why repurposing matters so much
Testing medicines that are already approved and known to be safe for other conditions is what doctors call repurposing. It matters enormously, because if one of these drugs turns out to work against Alzheimer’s, it could reach patients far sooner than a drug developed from scratch.
The safety data already exists. The manufacturing already exists. The long road from laboratory to clinic becomes much shorter, because the earliest and riskiest stages of drug development — proving a medicine is safe enough to give to people — have already been done.
There is a cost argument, too. Both metformin and atomoxetine are long-established medicines rather than new patented products, so a positive result would not automatically come with the kind of price tag that has made the newest Alzheimer’s drugs so contentious.
Crucially, this Alzheimer’s trial will not stop with these two drugs. AD-SMART is built to take new drugs coming through the research pipeline, and biotech and pharmaceutical companies will be able to bring their own candidates straight into it. Drugs that fail will be swapped out; new ones will come in. It is a standing research engine rather than a one-off test.
Who can take part in the AD-SMART trial
The trial aims to recruit 1,200 people to test the first two drugs. The first participants have already been recruited at Cambridgeshire and Peterborough NHS Foundation Trust and Surrey and Borders Partnership NHS Foundation Trust, with sites at Imperial College Healthcare NHS Trust, Edinburgh and Southampton now open.
Up to 20 NHS sites are expected to open over the next 12 to 18 months, with more than 30 planned overall. Participants are being recruited across the UK, and the trial will look at whether the drugs can ease memory and thinking problems and help people keep their quality of life as the disease progresses.
How to register your interest
People with a confirmed Alzheimer’s diagnosis who would like to take part can register their interest by contacting the AD-SMART recruitment co-ordinator at adsmart@psych.ox.ac.uk or on 01865 283806, or the Alzheimer’s Research UK Infoline at infoline@alzheimersresearchuk.org or on 0300 111 5111.
The Join Dementia Research website also lists AD-SMART and other studies looking for volunteers, and the official AD-SMART trial page carries the latest details of the study and its sites.
What treatment do people with Alzheimer’s get on the NHS today?
To understand why this trial matters, it helps to be clear about where treatment stands now. Around 600,000 people in the UK are living with Alzheimer’s, and there are currently no NHS treatments that slow or stop the underlying disease. Everything the health service can offer today is aimed at easing symptoms, not changing the course of the illness.
Four medicines that ease symptoms
According to the Alzheimer’s Society’s guide to dementia treatments, four medications are approved in the UK to ease some dementia symptoms: donepezil, rivastigmine, galantamine and memantine. They can temporarily help with memory and thinking, but no current medication stops, slows down or reverses dementia.
When one of these medicines does help, the improvement usually appears after a few weeks and typically lasts for between six and twelve months before symptoms gradually worsen again, even while the person is still taking it. The medicines are usually started around the time of diagnosis, following assessment by a GP or memory service.
It is also worth remembering that not every memory problem is Alzheimer’s. Some causes of memory and thinking difficulties are treatable — vitamin B12 deficiency is one of them, which is why blood tests form part of a dementia assessment. FamePost’s explainer on vitamin B12 deficiency symptoms and NHS testing sets out the signs to watch for.
The breakthrough drugs NICE turned down
The first drugs shown to slow Alzheimer’s itself — lecanemab and donanemab, which clear the toxic amyloid protein from the brain — were licensed in Britain in 2024. Trial results suggested lecanemab could slow memory decline by up to 27 per cent over 18 months.
But NICE, the body that decides what the NHS in England can fund, rejected their routine use, concluding that the benefits were too small to justify the substantial cost of the drugs themselves, the regular infusions and the intensive monitoring for side effects. The decision has been challenged on appeal, dementia experts have pressed the government to approve the drugs, and the appraisal has been re-examined — but at the time of writing, neither drug is routinely available on the NHS.
That stalemate is part of the backdrop to AD-SMART. If a cheap, familiar, repurposed medicine can be shown to help — even modestly — it would face none of those delivery problems.
The scale of dementia in Britain
Alzheimer’s is the most common cause of dementia, but it sits within a much bigger national picture. Research commissioned by Alzheimer’s Society shows that around a million people in the UK are now living with some form of dementia, and one in three people born in the UK today will develop dementia during their lifetime.
By 2040, the number of people living with the condition in the UK is expected to reach 1.4 million. The economic weight is just as stark: a report commissioned by Alzheimer’s Society in 2024 put the cost of dementia to the UK at £42 billion a year, rising sharply to £90 billion by 2040 — with the majority of that cost borne by people living with dementia and their families, and unpaid carers saving the economy an estimated £21 billion a year.
Against numbers like those, the value of an Alzheimer’s trial that can test drug after drug without starting again each time becomes obvious. Every year of delay is a year in which hundreds of thousands of families have no new options at all.
What “results by 2030” really means
The team expects to finish evaluating the first two drugs in 2030 — roughly four years from now. It is worth being clear-eyed about what that means, because dementia research has a long history of headlines that over-promised.
A result in 2030 will not be a cure. It will be an answer to a specific question: did metformin or atomoxetine do anything meaningful for people with Alzheimer’s, compared with a placebo? The trial measures things like memory and thinking problems and quality of life — the day-to-day reality of the disease, not just numbers on a scan.
There is every chance the answer for these first two drugs is “no”. That is how drug testing works, and it is how the platform design is meant to work: find out quickly, drop the drug, bring in the next one. MND-SMART’s first drugs failed too, and the trial carried on with new candidates. A negative result in 2030 would not be a failure of the trial — it would be the trial doing its job at speed.
What is genuinely different here is the pace and the efficiency. For families who have watched Alzheimer’s research grind along at one drug per decade, a trial that can test, drop and replace drugs on a rolling basis changes the route from lab to clinic.
“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. We are applying advances from cancer and other conditions to accelerate testing of treatments for people with Alzheimer’s disease.”
That was Professor Paresh Malhotra, one of the trial’s leaders, explaining why the platform approach matters. “For people living with Alzheimer’s disease, time is precious,” said Dr Sheona Scales, Director of Research at Alzheimer’s Research UK.
What happens next
The people already taking part
Among the first to join the trial is Heather Ransome, 67, from the Isle of Wight, who was diagnosed with Alzheimer’s in 2024. She said the one drug she was offered after her diagnosis had been around for many years, and that joining the trial had given her some hope.
“It’s not too taxing, just some extra tablets to take every day. I don’t know whether I’m being given the active treatment, but if it helps me, or helps others in future, that feels positive.”
The trial has also won the backing of the Prime Minister. Andy Burnham, whose father died from Alzheimer’s last month, said he knew how it felt to lose a loved one to dementia, having seen first-hand the devastating impact of the disease on families.
“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,” he said.
The Prime Minister has said he has made dementia research a national priority.
Recruitment is under way, and more NHS sites will open across the country through the rest of this year and into next. More drugs are expected to join the AD-SMART trial during the four-year window before the first readouts, and Alzheimer’s Research UK is already inviting clinicians and researchers to nominate drug candidates for future arms of the trial through its Dementia Drug Prioritisation Programme.
Nobody is claiming this trial will cure Alzheimer’s. But for the first time, Britain has a trial built to ask hard questions about many drugs, quickly — and to keep asking them as long as there are new candidates worth testing. For the hundreds of thousands of families living with this disease right now, that is no small thing.
