Research Personality: Dr. Suraya Yusoff
Dr. Suraya Yusoff, Psychogeriatricians, Hospital Sultan Ismail, Johor Bahru
Running a Clinical Trial for an Alzheimer’s Drug
Dr. Suraya Yusoff is a psychogeriatrician — a psychiatrist who specialises in the assessment and treatment of elderly people with mental health issues. She is one of the few psychogeriatricians in Malaysia. Currently she is based at the Hospital Sultan Ismail in Johor Bahru, where she runs a clinical trial for a drug to treat Alzheimer’s. She talks to Sharmila Valli Narayanan about the challenges of running a clinical trial for Alzheimer’s patients and explains the importance of such trials for patient care.
Dr. Suraya Yusoff is soft spoken and calm – two qualities very much needed when dealing with patients with psychiatric problems. She specialises in psychogeriatrics, a branch of psychiatry that deals with the study, prevention and treatment of mental disorders in elderly people.
As a medical student, she had been attracted to psychiatry, but her parents discouraged her from pursuing it. “There was and still is a stigma attached to psychiatry. People think it deals with people who have gone mad. My parents wanted me to try something else,” says Dr. Suraya. Consequently, she started off her career in paediatrics but circumstances were such that she ended up specializing in psychiatry anyway. Dr. Suraya was attracted to psychiatry because she saw it as providing more holistic treatment for patients.
“I felt that in other fields of medicine you treated the physical aspect of the patient, sometimes without looking into personhood, while in psychiatry you have to establish a relationship even before you can start treating the patient. So it is not just a matter of looking at the physical symptoms but needing to balance the patient’s emotional needs as well. I liked this personal relationship aspect of psychiatry.”
Dr. Suraya, who graduated from University Malaya in 1984, went into psychogeriatrics thanks to a meeting with a visiting psychogeriatrician from the United Kingdom when Dr. Suraya was doing her postgraduate studies in Universiti Kebangsaan Malaysia. This was in the early 1990s and psychogeriatry was a relatively new field in the United Kingdom as well. Psychogeriatry was introduced in the United States (where it is known as geropsychiatric or geriatric psychiatry) in 1984. With an aging baby boomer population, the doctors in the West realised this segment of the population had special psychiatric needs that were not being meet.
What especially attracted Dr. Suraya to this new field was the large amount of community work involved. “You were not stuck in the hospital all the time. In places like the United Kingdom, the doctors do a lot of work with the community where they visit patients’ homes,” she says. “Plus, I enjoy working with elderly people – generally they are a very nice group of people to work with.”
Dr. Suraya did her sub specialization in psychogeriatry in the United Kingdom right after she completed her gazettement as a MOH psychiatrist in late 1994. She returned to Malaysia in 1996 as the first psychogeriatrician in the country and was posted to Hospital Sultanah Aminah in Johor Bahru where she set up a psychogeriatic unit in 1998. The unit was later moved to Hospital Sultan Ismail (HSI) when she was transferred there.
At present, Dr. Suraya also trains other doctors in this field and has the distinction of being the only psychogeriatric in the country who oversees a community psychogeriatric service. “I have two nurses under me and we cover an area of about 40km,” explains Dr. Suraya. “We see patients who have severe dementia, behavioural problems, are not mobile and therefore not able to come to the clinic at HSI. As a psychogeriatrist I don’t just focus on the treatment but also act as a physician to these patients because most often they also have other physical illnesses such as diabetes, high blood pressure, to name a few.”
Hospital Sultan Ismail, Johor Bahru
Running a clinical trial for Alzheimer’s
Dr. Suraya is also involved in running a Phase 3 clinical trial on an anti-dementia drug specifically for Alzheimer’s patients. She explained about the meaning of the different phases a new drug goes through before it reaches the public.
This particular clinical trial is a 15 month study of patients with mild to moderate Alzheimer’s disease. It is a multicentre study which involves the US, Europe, Asia and Australia. Malaysia is one of the two countries chosen from Southeast Asia. The trial started at the end of 2013 when the doctors involved were given a year to recruit patients for the study. The trial will end in mid 2015.
Challenges faced
Two phases of the trial will be run. The first (which is ongoing) is a double blind study, informed Dr. Suraya. “In a double blind trial, the doctors and the patient don’t know whether the drug used is the actual drug or a placebo. In the open label trial the doctors will know whether the patient is being given the drug or the placebo.”
Only three centres in Malaysia are being used in this clinical trial: HSI in Johor, UniKL Royal College of Medicine Perak and University Malaya Medical Centre (UMMC). The target was to recruit 10 patients for each centre. Unfortunately, meeting this target has been tough. “For HSI we selected 16 patients for the trial, but in the end only 5 were deemed fit for the study; in Ipoh 19 were screened but only 9 were finally selected for the trial and in UMMC, out of the 5 patients who were selected only 1 made it into the trial. So instead of having 30 patients for the trial, we only managed to get 15 patients – that’s barely more than half,” discloses Dr. Suraya.
Dr. Suraya listed several reasons why it has been difficult to recruit patients for this clinical trial . “Most Malaysians are not used to being a part of a clinical trial and they are not sure of what to expect. With Alzheimer’s patients there are additional challenges inrecruiting them for clinical trials.
Most of them can’t make decisions on their own because of their impaired cognition which makes it difficult for them to give consent. The decision has to be made by their primary caregiver which could be one of their children. But in Asian families, the decision is not made by the main caregiver alone; often times the whole family will be involved in the decision making and this can take time and become complicated.”
“Some patient who are already on an anti-dementia drug are very reluctant to try a new drug especially one that is being tested on patients,” continues Dr. Suraya. “They don’t want to be a guinea pig.
Communication between doctor and patients is essential during the clinical trial period. With Alzheimer’s patients, most often it is the caregiver who has to communicate to the doctor on how the patient is feeling and whether they are experiencing any side effects because the patients themselves are unable to do so. “On my side the problem I face is that the doctors under me tend to move around to other departments and I am not able to have the same set of doctors and nurses to monitor and rate the patient”, notes Dr. Suraya.
Despite the challenges, the trial has been progressing well and Dr. Suraya is looking forward to when the trial enters the open label phase. According to The Alzheimer’s Society, the disease affects about 36 million people around the world. Many countries in Asia, with an increasing ageing population can expect more people to develop the disease in future.
Dr. Suraya hopes that there will be more such clinical trials for Alzheimer’s in the future and that Malaysia will be included in the list of countries where the trials will be carried out. “Such trials for Alzheimer’s drugs are very important because we need to advance the care and treatment for this devastating disease. Right now there are only about three types of drugs used for treating patients and we need to find more. This disease might affect us and I hope that should I get it 30 or 40 years from now I hope to God that there are more effective drugs available for treatment. The only way we can get such drugs is to learn their efficacy via clinical trials. I sincerely hope that in future if there are more such trials, my colleagues in the medical fraternity will be more willing to be involved in the trials.”
She also has advice for Malaysians who are approached to take part in clinical trials.
“I fervently hope that Malaysians are more daring to come forward and be part of clinical trials. Malaysians are generally afraid of the unknown. I would like to assure them that being part of a clinical trial is the safest place to be because the patient is given excellent care during the clinical trial. At this stage, the drug has undergone a lot of tests and is safe for humans. Doctors monitor the patient every few months and look out for any side effects, so there is really nothing to worry about,” sums up Dr. Suraya.
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