• Home
  • Health & Wellness
  • Disclaimer
    • Terms of Use
    • Privacy Policy
    • DMCA Notice
  • Home
  • Health & Wellness
  • Disclaimer
    • Terms of Use
    • Privacy Policy
    • DMCA Notice
24/7 Health News
No Result
View All Result
Home Article

New Alzheimer’s drugs don’t deserve the hype – here’s why

August 31, 2023
in Article
New Alzheimer’s drugs don’t deserve the hype – here’s why

Brian A Jackson/Shutterstock

A prominent childhood memory is of my grandparents living with and then dying from dementia. As is universal with dementia, there was a double blow: watching my grandparents lose their identity and seeing the suffering of those closest to them.

As a junior doctor on a specialist dementia ward when I was in my 20s, I watched the same stories play out for family after family, feeling largely powerless to help. Now in my 30s, I conduct public health research to understand what we can do to prevent, delay or improve the experience of dementia – the leading cause of death in England.

Naturally, this makes me desperate for good news on treatment options for Alzheimer’s disease – the main cause of dementia. Enter three drugs (aducanumab (trade name Aduhelm), lecanemab (Leqembi) and donanemab) that remove amyloid, the protein thought to cause Alzheimer’s disease. Unlike their many predecessors, that also successfully removed amyloid from the brain, these drugs were the first to slow cognitive decline.

This breakthrough was hailed as “the beginning of the end for Alzheimer’s disease”, but how useful are these drugs going to be? There are four key shortcomings to consider:

1. Tiny benefits: In the donanemab trial, the people taking the drug declined on average by ten points on a 144-point cognitive scale. The placebo group declined by 13 points.

Consistent with the patterns in the trials of the other two drugs, this tells us that all groups in all these trials declined and the amount of decline that was avoided by taking the drug – in this case donanemab – (three points) was a lot smaller than the amount of decline that still occurred (ten points). The difference in the amount of decline was so small that it would probably not be noticeable to the doctors looking after these patients.

2. Side-effects: Through regular magnetic resonance imaging (MRI) scans, one in six people taking lecanemab was found to have evidence of brain bleeding, and one in eight had brain swelling.

Regular scans will sometimes pick up these pathologies in dementia patients. And, indeed, one in 11 of those in the placebo group had evidence of bleeding, while one in 59 had swelling. For most people, these events were only detectable by MRI and not through showing any specific symptoms. However, the effects of this drug’s damage to the brain, particularly the long-term effects, are unknown.

Sadly, there have also been a few deaths attributed to these drugs.

3. Very expensive: Aducanumab was marketed in the US for US$45,000 (£35,000) per patient per year (later reduced to US$20,000 to increase demand), and lecanemab for US$26,500. This is just for the drug itself. Health systems also need to pay for additional scans to test for eligibility, monitoring and management of side-effects, and staff to run infusion clinics.

The donanemab trial suggested that treatment could end when brain scans showed sufficient amyloid clearance. But we don’t know if amyloid will return after some time. Regular monitoring for amyloid recurrence and repeated bouts of treatment would add further costs.

There are other impositions for patients: attending centres every two to four weeks for drug infusions and regular monitoring and worrying about side-effects.

A patient’s arm being prepared for an infusion.
Patients would need regular infusions.
Dragon Images/Shutterstock

4. Highly selective trials: It is accepted that not all trial “efficacy” (the effect seen in a specialised trial context, designed to maximise the likelihood of treatments working, such as including only uncomplicated cases) will convert into clinical “effectiveness” (the effect seen when drugs are given to relatively more complex patients in busy, real-world clinical settings). This is concerning, because there’s little wriggle room before the effects become undetectable. And, while this is the case for all diseases, Alzheimer’s is likely to be an extreme example.

For every ten patients that doctors thought might be eligible for these trials, seven or eight were rejected. People with brain pathologies other than amyloid, such as vascular damage or Lewy bodies, and those with significant other medical problems, which might have clouded the trial results and increased the risk of side-effects, were excluded.

If the drug eligibility is restricted to match the trial eligibility, then very few people will be eligible. If eligibility is broader, then already small effects are likely to be even smaller and side-effects more pronounced.

Profound shortcomings

There’s more. The trials selected people at the earliest stages of the disease – that is, when symptoms had only recently developed – and successfully cleared amyloid, yet patients still declined almost as fast. So inevitably, researchers ask: maybe we need to start the drugs even earlier? But how?

People in the trials were, on average, five to ten years younger than most people are at Alzheimer’s diagnosis in the US and UK. And catching people earlier in the disease is problematic because most people with amyloid but no cognitive symptoms won’t get dementia before they die.

Sadly, I don’t think these drugs can make a big difference for people currently, or soon to be, living with Alzheimer’s disease. Also, the shortcomings are so profound, despite decades of expensive trials and patient sacrifice, I think it’s time to take the amyloid blinkers off and prioritise exploring other, neglected, options for treating dementia.

This isn’t the beginning of the end of Alzheimer’s, but perhaps it should be the end of the anti-amyloid drug pathway.

The Conversation

Sebastian Walsh is a Doctoral Fellow at the University of Cambridge. He receives funding from the National Institute for Health and Care Research (NIHR). The views expressed here are his own.

ShareTweetSharePin
Next Post
COVID-19 vaccine boosters are the best defence: Older adults shouldn’t rely on previous infection for immunity

COVID-19 vaccine boosters are the best defence: Older adults shouldn’t rely on previous infection for immunity

Most Read

What causes stuttering? A speech pathology researcher explains the science and the misconceptions around this speech disorder

What causes stuttering? A speech pathology researcher explains the science and the misconceptions around this speech disorder

December 15, 2022
morning back pain

Morning Again Ache Trigger Is Not the Mattress

October 11, 2021

Why Circadian Rhythms Matter for Your Health

July 30, 2024
lower back pain relief exercises

5 decrease again ache aid workouts

October 11, 2021

4 steps to building a healthier relationship with your phone

January 28, 2025
3 years after legalization, we have shockingly little information about how it changed cannabis use and health harms

3 years after legalization, we have shockingly little information about how it changed cannabis use and health harms

October 15, 2021
Nasal vaccines promise to stop the COVID-19 virus before it gets to the lungs – an immunologist explains how they work

Nasal vaccines promise to stop the COVID-19 virus before it gets to the lungs – an immunologist explains how they work

December 14, 2022
bleeding in gum

When The Bleeding in gum Is Severe ?

October 11, 2021
Good Night Sleep

6 Causes of Good Evening Sleep

October 11, 2021
Kick up your heels – ballroom dancing offers benefits to the aging brain and could help stave off dementia

Kick up your heels – ballroom dancing offers benefits to the aging brain and could help stave off dementia

January 3, 2023
Biden is getting prostate cancer treatment, but that’s not the best choice for all men − a cancer researcher describes how she helped her father decide

Biden is getting prostate cancer treatment, but that’s not the best choice for all men − a cancer researcher describes how she helped her father decide

May 20, 2025
Ten small changes you can make today to prevent weight gain

Ten small changes you can make today to prevent weight gain

October 12, 2021

COVID vaccines: how one can pace up rollout in poorer international locations

October 5, 2021

This Simple Hygiene Habit Could Cut Your Risk of Stroke, New Research Reveals

February 1, 2025

Multiple sclerosis: the link with earlier infection just got stronger – new study

October 12, 2021
Support and collaboration with health-care providers can help people make health decisions

Support and collaboration with health-care providers can help people make health decisions

December 16, 2021
Greece to make COVID vaccines mandatory for over-60s, but do vaccine mandates work?

Greece to make COVID vaccines mandatory for over-60s, but do vaccine mandates work?

December 1, 2021
Five ways to avoid pain and injury when starting a new exercise regime

Five ways to avoid pain and injury when starting a new exercise regime

December 30, 2022
woman covered with white blanket

Exploring the Impact of Sleep Patterns on Mental Health

August 4, 2024

Maximize Your Performance – Sync with Your Circadian Rhythms

August 9, 2024
Why are some people faster than others? 2 exercise scientists explain the secrets of running speed

Why are some people faster than others? 2 exercise scientists explain the secrets of running speed

April 29, 2024
Backlash to transgender health care isn’t new − but the faulty science used to justify it has changed to meet the times

Backlash to transgender health care isn’t new − but the faulty science used to justify it has changed to meet the times

January 30, 2024
News of war can impact your mental health — here’s how to cope

Binge-eating disorder is more common than many realise, yet it’s rarely discussed – here’s what you need to know

December 2, 2022
As viral infections skyrocket, masks are still a tried-and-true way to help keep yourself and others safe

As viral infections skyrocket, masks are still a tried-and-true way to help keep yourself and others safe

December 14, 2022
GPs don’t give useful weight-loss advice – new study

GPs don’t give useful weight-loss advice – new study

December 16, 2022
Nutrition advice is rife with misinformation − a medical education specialist explains how to tell valid health information from pseudoscience

Nutrition advice is rife with misinformation − a medical education specialist explains how to tell valid health information from pseudoscience

January 28, 2025
FDA limits access to COVID-19 vaccine to older adults and other high-risk groups – a public health expert explains the new rules

FDA limits access to COVID-19 vaccine to older adults and other high-risk groups – a public health expert explains the new rules

May 21, 2025
Four ways to avoid gaining weight over the festive period – but also why you shouldn’t fret about it too much

Four ways to avoid gaining weight over the festive period – but also why you shouldn’t fret about it too much

December 22, 2022
Nurses’ attitudes toward COVID-19 vaccination for their children are highly influenced by partisanship, a new study finds

Nurses’ attitudes toward COVID-19 vaccination for their children are highly influenced by partisanship, a new study finds

December 2, 2022
How hot is too hot for the human body? Our lab found heat + humidity gets dangerous faster than many people realize

How hot is too hot for the human body? Our lab found heat + humidity gets dangerous faster than many people realize

July 6, 2022
  • Home
  • Health & Wellness
  • Disclaimer

© 2020 DAILY HEALTH NEWS

  • Home
  • Health & Wellness
  • Disclaimer
    • Terms of Use
    • Privacy Policy
    • DMCA Notice

© 2020 DAILY HEALTH NEWS