A cheap drug may slow down aging. A study will determine if it works
MICHEL MARTIN, HOST:
A drug that is widely used to treat diabetes is being studied for its potential to slow down biological aging. As part of our series How To Thrive As You Age, NPR's Allison Aubrey reports on a study that aims to determine whether an inexpensive, generic drug can help protect against other conditions from cancer to heart disease to dementia.
ALLISON AUBREY, BYLINE: Michael Cantor is a 65-year-old patent attorney who lives in West Hartford, Conn. And when he thinks about his family medical history, he gets a little anxious.
MICHAEL CANTOR: My father had a heart attack - his first heart attack at age 51, and he passed away at age 68. So I certainly have heart disease in my family.
AUBREY: He wants to prevent this, but about a decade ago, his weight and his blood sugar were headed in the wrong direction. So he started taking a drug called metformin. The drug was first used in France in the 1950s to help control blood sugar, and in recent years, there's growing evidence that it may do much more.
CANTOR: I tell all my friends about it. Many of our friends, including my siblings, have asked their own doctors to put them on it. You know, 'cause we all want to live a little longer life and, you know, high quality of life if we can.
AUBREY: So can taking metformin promote a longer life? I reached out to Steven Austad, a senior scientific advisor at the American Federation for Aging Research. He's a biogerontologist who studies the biology of aging.
STEVEN AUSTAD: I don't know if metformin increases lifespan in people, but I'd certainly like to find out because the evidence that exists suggests that it very well might.
AUBREY: The drug is a derivative of guanidine, a compound found in an herbal medicine called goat's rue. Since the FDA approved it back in the 1990s, millions of people have taken metformin, and researchers have documented some surprising findings.
AUSTAD: Gradually, people became aware, oh, not only is this controlling their diabetes, but it looks like these people are getting less cancer. And that was sort of a shock. And then it turns out that people on metformin were getting less dementia. So it's very rare that you get dozens of studies that all point in the same direction.
AUBREY: As promising as this sounds, most of the evidence is observational. These studies suggest that people who take metformin for diabetes may also reduce their risks of cancer and cognitive decline. Now, researchers want to know whether the drug can do the same in healthy people. Austad says it's possible.
AUSTAD: Metformin is well known to reduce inflammation, and inflammation is one of those processes that cuts across diseases. It's involved in heart disease. It's involved in dementia. It's involved in cancer. It's involved in virtually all of the things that we know go wrong with aging.
AUBREY: In 2015, Austad and a bunch of aging researchers began pushing for a clinical trial to study this.
AUSTAD: A bunch of us went to the FDA to ask them to approve a trial for metformin for preventing a variety of diseases or delaying a variety of diseases. If you could prevent multiple problems at the same time, like we think metformin may do, then that's almost the ultimate in preventative medicine.
AUBREY: The agency was receptive, he says, and the researchers designed to study. The aim is to enroll 3,000 people between the ages of 65 and 79 for a six-year trial. Dr. Nir Barzilai of Albert Einstein College of Medicine leads the fundraising efforts to get it off the ground but it's been slow going.
NIR BARZILAI: The main obstacle with funding this study is that metformin is a generic drug, so no pharmaceuticals is tending to make money out of that. And that's why we didn't have the support we could have had.
AUBREY: So he's turned to philanthropists and foundations. The National Institutes of Health set aside about $5 million for the research, but that's not enough to pay for the trial, which is estimated to cost between 45 and $70 million. Barzilai says a lot of people could benefit if the trial points to success.
BARZILAI: There would be many people that can be using the drug immediately, and it's something that everybody will be able to afford.
AUBREY: The FDA does not recognize aging as a disease to treat, but the hope is that this would usher in a paradigm shift away from treating each age-related medical conditions separately to treating these conditions together by targeting aging itself. For now, metformin is indicated just for the treatment of type-two diabetes. But Michael and his wife, Shari Cantor, found their doctors were comfortable prescribing it to them off label. Given the drug's long history of safety and the possibility it may help delay age-related diseases, both say they feel very healthy.
CANTOR: I walk a lot. I hike, you know, at 65, I have a lot of energy, and I feel like the metformin helps that.
AUBREY: Though metformin has been shown to be very safe, all drugs have some side effects. A small percentage of people who take metformin experience an upset stomach or GI troubles that make the drug intolerable, and some people develop a B12 deficiency. Dr. Eric Verdin of the Buck Institute for Research on Aging points to a study that those over 65 who take metformin may have a harder time building new muscle.
ERIC VERDIN: There's some evidence that people who exercise who are on metformin have less gain in muscle mass, which we know, you know, is a good predictor against aging.
AUBREY: But he says it may be possible to repurpose metformin in other ways.
VERDIN: There are a number of companies that are exploring metformin in combination with other drugs that might be able to promote healthy longevity.
AUBREY: He points to research underway to combine metformin with a drug called galantamine for the treatment of sarcopenia, which is a medical term for age-related muscle loss, a condition that affects millions of older women. For now, Dr. Barzilai says the metformin clinical trial can get underway when the money comes in, and he continues to fundraise.
Allison Aubrey, NPR News.
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