New Alzheimer’s Drugs Don’t Deserve the Hype – Here’s Why

New Alzheimer’s Drugs Don’t Deserve the Hype – Here’s Why

Subject: Science and technology

Section: Health

Introduction

• Alzheimer’s disease is a progressive neurodegenerative disorder that causes cognitive decline, memory loss, and behavioral changes, primarily affecting older adults.
• Introduction to three drugs (aducanumab, lecanemab, and donanemab) that target amyloid, the protein linked to Alzheimer’s disease.
• The breakthrough in slowing cognitive decline.

Four Key Shortcomings of New Alzheimer’s Drugs

1. Tiny Benefits

• In the donanemab trial, drug-treated patients declined by an average of ten points on a 144-point cognitive scale.
• The placebo group declined by 13 points, indicating cognitive decline in all groups.
• The small difference in cognitive decline reduction may not be noticeable to doctors.

2. Side-Effects

• Regular MRI scans found evidence of brain bleeding in one in six lecanemab-treated individuals and brain swelling in one in eight.
• The long-term effects of these brain changes are unknown, and there have been a few deaths attributed to these drugs.

3. Very Expensive

• Aducanumab was initially marketed in the US for $45,000 per patient per year (later reduced to $20,000).
• Lecanemab costs $26,500 per patient per year.
• Additional costs include scans for eligibility, side-effect monitoring, infusion clinic staff, and ongoing amyloid clearance monitoring.
• Patients also face regular clinic visits and concerns about side effects.

4. Highly Selective Trials

• The trials were highly selective, excluding patients with conditions other than amyloid-related pathology and significant medical problems.
• The narrow eligibility criteria raise concerns about translating trial efficacy into real-world clinical effectiveness.

Additional Concerns

• The trials targeted patients at the earliest disease stages, but even with successful amyloid clearance, cognitive decline persisted.
• Participants in the trials were younger on average than typical Alzheimer’s patients.
• Advocates exploring alternative treatment options beyond anti-amyloid drugs.