Why This New Alzheimer’s Drug May Be More Than Just a Beacon of Hope

In Switzerland there are currently about 150,000 people with dementia, in more than 20 years it will probably be around 315,000 as society ages, according to calculations by Alzheimer Switzerland. Dementia not only affects the patients themselves, but also those around them. It’s no wonder that public reports of new Alzheimer’s drugs are associated with great hope.

Also in this case: The pharmaceutical companies Eisai and Biogen report promising results from the phase 3 clinical trial of the drug lecanemab. With this active ingredient, Alzheimer’s disease can be treated at an early stage.

“Early means that the patients still function normally in daily life and hardly need any help,” explains Ansgar Felbecker, president of the Swiss memory clinics and neurologist at the cantonal hospital of St.Gallen. Early also means that the proteins of Alzheimer’s disease, especially the amyloid protein deposit, must be detectable in the cerebrospinal fluid or through imaging.

Lecanemab specifically targets these protein deposits in the brain that are characteristic of Alzheimer’s disease. The drug is a monoclonal antibody. This is reminiscent of the drug Aducanumab, which was celebrated as a beacon of hope a year ago. felbecker says:

So the drugs are similar. However, the two active ingredients differ in the exact point of attack. Because the amyloid proteins can exist in the human brain in different forms – as proteins in the form of monomers, oligomers, protofibrils and mature fibrils. “And lecanemab is more targeted at protofibrils, which are considered particularly harmful,” says the senior physician in the Department of Neurology.

This is not the only reason why lecanemab is the most promising drug today, but also “because the phase 3 trial in particular showed the more convincing results,” explains Felbecker. Much has been said about hope, which is why many are skeptical. Too often there have been disappointments in Alzheimer’s research, euphoria would be out of place, says the dementia expert. “But this time there could actually be a better effect. The studies have now gained experience in about 2,000 patients.” Whether the beacon of hope really keeps what it promises can only be judged after experience with even larger patient groups.

Linda Thienpont, Head of Science at the Alzheimer’s Research Initiative in Germany, is cautiously optimistic about the results. According to Thienpont, in a phase 3 study, for the first time, an active substance that disrupts the mechanisms of Alzheimer’s disease could improve memory performance. However, the improvement achieved compared to the control group was moderate.

According to the study, lecanemab shows advances in side effects that are lower than other Alzheimer’s drugs. “In any case, the dreaded side effects, the so-called ‘aria’, ie brain swelling and minor bleeding in the brain, seem to be much less common than with aducanumab,” says Felbecker. Above all, it is important that in most cases where such abnormalities were seen on the MRI examination, no symptoms occurred. In those cases, he would not speak of side effects at all, but of a positive signal that the treatment actually triggers something in the brain.

It is also discussed whether the way to fight amyloid is the right one, since this protein is only one factor in dementia. There are also active ingredients that counteract tau proteins. Both are promising approaches, Felbecker says.

“Amyloid is a key factor in the development of Alzheimer’s disease, and fighting it now appears to be working. But in the long term, therapies against tau proteins and other factors of the disease will probably also be needed to really stop the disease.”

The price of a therapy is always criticized, especially given the renewed rise in health and health insurance costs. Nothing is known about the price of lecanemab. But the prices of such new drugs are often very high. This is due to the fact that the development costs of new drugs and the risk of the active ingredient failing during the study process are very high.

Companies want to recoup this high cost after the success of a drug, so the high price has its economic logic. Especially since these companies also have to build reserves to have money for the development of new drugs and therapies. “Without research by the pharmaceutical industry, progress in drug therapies would be very small,” says the president of the Swiss Memory Clinics.

On the other hand, of course, there are the ever-increasing health costs, so reasonable compromises must always be found. “But you also have to take into account that by far the largest costs in dementia are currently incurred in outpatient and inpatient care. If an effective drug lowered these costs a little bit, wouldn’t that justify a higher price?” Felbecker wonders. Such considerations should also be considered in the price negotiations with the companies following an eventual approval of lecanemab.

Lacanemab can thus be described as a promising therapy. However, detailed research results will not be presented until the end of November. Then the dementia specialists get their money’s worth again. Unfortunately, one thing also applies to this drug: Lecanemab can’t cure Alzheimer’s disease, but it might at least slow it down at some point. (aargauerzeitung.ch)