Recent advances in Alzheimer’s treatment have generated excitement, particularly around new drugs that target amyloid proteins in the brain.
However, researchers from Cambridge Public Health are questioning whether these drugs will make a significant difference in reducing the overall impact of Alzheimer’s disease.
Their concerns were detailed in a study published in Alzheimer’s & Dementia.
Alzheimer’s disease is believed to cause about 70% of the 55 million cases of dementia worldwide.
One of the hallmarks of Alzheimer’s is the build-up of amyloid plaques in the brain, which many scientists believe triggers the disease’s symptoms.
Recent drugs, known as amyloid immunotherapies, aim to clear these plaques by harnessing the immune system.
Two large clinical trials have shown that these drugs can slow down the cognitive and functional decline in patients with early Alzheimer’s.
However, the researchers from Cambridge argue that the benefits seen in these trials were minimal. In fact, they suggest that doctors might struggle to notice a significant difference between patients who took the drug and those who didn’t after 18 months of treatment.
Moreover, these drugs are associated with serious side effects, including brain swelling and bleeding. In one trial for the drug donanemab, three deaths were linked to the treatment. The long-term effects of these drugs remain unclear, as the trials only lasted 18 months.
Despite these concerns, the U.S. Food and Drug Administration (FDA) has already approved two amyloid-targeting drugs. However, the European Medicines Agency (EMA) has recommended rejecting one of these drugs, lecanemab, due to the small benefits and significant risks. The UK’s regulatory agency is expected to make a decision soon.
Professor Edo Richard from Radboud University Medical Centre in the Netherlands, a co-author of the study, expressed concern that these drugs are being hyped as a solution for all Alzheimer’s patients. In reality, the trials involved a very specific group of patients with early symptoms, and these participants were younger than the average person who develops Alzheimer’s.
Dr. Sebastian Walsh, the lead author of the study, added that if the drugs are approved, only a small group of patients would likely benefit. These individuals would need thorough assessments before receiving the treatment, which could place a heavy burden on already strained healthcare systems.
The researchers also worry that rolling out these treatments would require significant resources, while leaving many Alzheimer’s patients without options. Professor Carol Brayne, co-director of Cambridge Public Health, pointed out that most cases of dementia occur in low- and middle-income countries, where these drugs would likely be inaccessible.
The team concludes that while amyloid immunotherapies might offer some hope for a select group of patients, they are unlikely to address the broader issue of dementia.
They emphasize the need to explore other approaches that could have a more significant impact on preventing and treating dementia in larger populations.
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