Title: New Breakthrough Therapies Provide Hope for Early Alzheimer’s Patients
New therapies targeting early-stage Alzheimer’s disease are bringing renewed hope to individuals and families affected by this debilitating condition. Monoclonal antibodies, designed to remove amyloid-β plaques in the brain, have shown significant potential in slowing down cognitive decline. To aid neurologists in discussing these therapies with patients and caregivers, the American Academy of Neurology has released an informative article in Neurology®, their prestigious medical journal. The article aims to provide expert consensus on emerging Alzheimer’s treatments, offering valuable guidance in patient care decision-making.
According to Dr. Carlayne E. Jackson, President of the American Academy of Neurology, neurologists play a crucial role in the lives of millions of Alzheimer’s patients, and with the advent of these groundbreaking therapies, clear communication between clinicians and patients becomes essential. The article provides an overview of the available evidence regarding anti-amyloid monoclonal antibodies, enabling informed decision-making and empowering patients and caregivers in the treatment process.
The Emerging Issues in Neurology article, authored by Dr. Vijay K. Ramanan from the Mayo Clinic, discusses the potential benefits and implications of lecanemab, aducanumab, and donanemab. While acknowledging that the formal evidence base is still evolving, the article emphasizes the likelihood that these new therapies will become an essential part of the neurologist’s toolkit in managing Alzheimer’s disease.
Lecanemab, one of the monoclonal antibodies, received traditional FDA approval in July 2023. Aducanumab, albeit given accelerated approval in June 2021, is not yet approved for standard use and is currently limited to participants in clinical trials. The FDA’s decision on traditional approval for donanemab is expected later this year.
The article clarifies eligibility criteria for receiving these therapies, which currently include individuals with early symptomatic forms of Alzheimer’s, mild cognitive impairment, or mild dementia due to the disease. Certain genetic risk factors and a history of specific types of strokes must be considered and discussed with potential candidates to mitigate the risk of amyloid-related imaging abnormalities (ARIA), characterized by brain swelling and potentially fatal bleeding. As a result, individuals taking anticoagulant medications commonly prescribed to older adults may be ineligible for treatment. Notably, three deaths have been linked to lecanemab, with at least two of those fatalities occurring in patients simultaneously taking anticoagulant medications.
Although the primary goal of these therapies is to slow cognitive decline by removing amyloid-β plaques, it is important to note that they are not a cure for Alzheimer’s disease. Additionally, the article highlights that the reduction in the rate of cognitive decline observed in some studies over an 18-month period may not be immediately noticeable to patients undergoing these treatments.
The article also addresses the high cost involved in administering these therapies, including expenses related to diagnostic testing, treatment administration, and safety monitoring. Regular infusions and repeated brain scans are required, further complicated by the shortage of neurologists and healthcare professionals necessary to provide adequate care for the anticipated demand.
In terms of diversity, the article voices concern over the underrepresentation of Black and Hispanic individuals in previous studies. Given that dementia incidence is higher among these populations compared to the white population, it emphasizes the need for future studies to include a more diverse range of participants.
Dr. Ramanan concludes by acknowledging the optimism surrounding anti-amyloid monoclonal antibodies as potential tools to slow the progression of Alzheimer’s disease. However, he highlights the necessity for further research to determine which individuals are most likely to benefit from these therapies and enable future advancements in Alzheimer’s care.
These breakthrough therapies offer new hope for individuals living with early-stage Alzheimer’s disease. While there are still questions to be answered and challenges to overcome, the emergence of anti-amyloid monoclonal antibodies represents significant progress in the fight against this devastating condition. With ongoing research efforts, there is a growing opportunity to improve outcomes, expand access to treatment, and provide holistic care to individuals affected by Alzheimer’s.
