Drugs that slow Alzheimer’s progression are hope – 07/25/2023 – Equilibrium and Health

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Recently, two new drugs slowed the progression of Alzheimer’s and excited doctors and patients alike. Despite being promising, the therapies have adverse effects, are not indicated for everyone and have not yet arrived in Brazil.

In today’s edition, I talk about advances in the search for treatment and early diagnosis of the disease.

New drugs against Alzheimer’s

In recent weeks, we have learned of advances in the treatment of Alzheimer’s. The first announcement was made in early July, with the approval by the FDA (American Food and Drug Administration) of the second drug for the early treatment of Alzheimer’s, the lecanemab (commercialized under the name Leqembi), from the pharmaceutical company Biogen. Lecanemab reduced Alzheimer’s progression by up to 27%.

On the 17th of this month, Eli Lilly announced surprising results from its global clinical trial with the drug. donanemabe, which helped slow cognitive decline in about half (47%) of patients with early Alzheimer’s symptoms. It also helped to reduce the progression of cognitive loss by up to 60% in those who already had some cognitive decline.

Although encouraging, the two announcements should be viewed with caution. They are still expensive drugs, lack approval in many countries and are more indicated for patients in the early stages of the disease with diagnostic imaging. I explain better below.

Let’s start with the lecanemab. The studies showed a 27% reduction in disease progression in participants aged 50 to 90 who received biweekly injections of the drug.

Yes but…There are still several points that must be evaluated before using the medicine. One of them is that some serious adverse effectssuch as edema (swelling) and brain hemorrhages in the patients in the study.

Another point, as explained to me by the professor of geriatrics at USP, Claudia Suemoto, is that lecanemab is indicated for patients in the initial phase, with verification of accumulation of beta amyloid plaques by PET-amyloid examination, something that is not accessible (and not indicated) for everyone.

already the donanemabeby Eli Lilly, was able to remove this accumulation of beta amyloid plaques regardless of the stage of the disease, thereby decreasing cognitive impairment.

But while both drugs have been shown to be effective in removing the amyloid buildup in the brain, the benefits to the patient’s quality of life—that is, how much it means in fact an evolution of the condition—are still unknown.

Therefore, although promising, therapies are not considered a silver bullet. It’s like Ivan Okamoto, a neurologist at the Center for Excellence in Memory at Hospital Israelita Albert Einstein, told me: “it’s not the last hope or the definitive solution”.

The doctor reinforces that the expectation generated by these new therapies can cause a worsening in the emotional state of patients who still do not have access to them. And it doesn’t hurt to remember that they still don’t have a forecast for use in Brazil.

Alzheimer’s diagnosis is not the end

In recent years, new imaging and blood tests have helped identify signs of early Alzheimer’s even before symptoms appear.

It is worth it? There is a debate among experts about how valid it is to have an early diagnosis of Alzheimer’s, long before the onset of symptoms.

• One quarter (25%) of patients with brain injuries associated with Alzheimer’s or dementia died without any symptoms;

• In addition, the anxiety generated by early diagnosis can be even more harmful.

“Sometimes it can take 20 to 30 years for the signs to appear”, says professor Suemoto, from USP, who coordinates the university’s Brain Bank.

A recent example is that of singer Tony Bennett, who died on the 21st, aged 96. He was diagnosed with Alzheimer’s in 2016, but the announcement was made public in 2021.

Active, he continued singing and made his last performance that year with singer Lady Gaga. His survival was approximately seven years, and the cause of death has not yet been clarified.

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