A groundbreaking study presented on Monday suggests that treating Alzheimer’s patients as early as possible, when symptoms and brain pathology are still mild, can significantly slow cognitive decline. The study, which involved 1,736 patients, focused on an experimental Alzheimer’s drug called donanemab, developed by Eli Lilly. It found that donanemab can modestly slow the progression of memory and thinking problems in the early stages of the disease, with the greatest effect seen in patients who had lower levels of a protein called tau, which contributes to the formation of brain tangles. The study, published in the journal JAMA, reported that donanemab appeared to delay decline in memory and thinking by approximately four and a half to seven and a half months over an 18-month period compared to a placebo. This effect was most pronounced in patients under 75 years old and those with a condition called mild cognitive impairment, which is considered a precursor to Alzheimer’s.
Dr. Daniel Skovronsky, Eli Lilly’s chief medical and scientific officer, emphasized the importance of early diagnosis and intervention in managing Alzheimer’s disease. He stated that the sooner treatment can be initiated, the greater the impact on the progression of the disease. The promising findings from this study, along with the recent approval of another drug called Leqembi that also slows decline in the early stages of Alzheimer’s, indicate a potential breakthrough in the search for effective medications for this devastating disease. Donanemab is currently under consideration for approval by the Food and Drug Administration.
It is worth noting that donanemab and Leqembi have not been directly compared to each other in research studies, and each drug carries its own safety risks, including swelling and bleeding in the brain. While these risks are often mild, they can be serious in some cases. Further research and data are needed to determine if the benefits of these drugs outweigh their potential harms.
Both donanemab and Leqembi target a protein called amyloid, which forms plaques in the brains of Alzheimer’s patients. Previous anti-amyloid drugs have failed to demonstrate significant improvements in memory or thinking problems. Donanemab and Leqembi are the first drugs of their kind to show clear evidence of slowing cognitive decline in the early stages of the disease. However, some experts question the clinical significance of the modest improvements seen with these drugs, as they may not be noticeable to patients and their families.
Other notable findings from the donanemab study include the observation that patients who reached a certain amyloid threshold and stopped receiving the drug continued to experience a slowing of decline. This raises questions about whether the decline would continue as amyloid levels increase again. Additionally, patients with intermediate levels of tau showed greater slowing of decline compared to those with high levels of tau.
One criticism of the study is the lack of diversity among participants, as the majority of patients were white. This highlights the need for more inclusive research to ensure that potential treatments are effective for all populations affected by Alzheimer’s, particularly historically marginalized communities.
The experience of a patient in another donanemab trial illustrates the challenges in assessing the effectiveness of these drugs in daily life. While the treatment appeared to clear plaques in his brain, it is unclear if it slowed his cognitive decline. His wife noted that although his symptoms had not significantly worsened, he struggled with tasks that he could previously perform easily. She expressed a desire to do anything possible to slow the progression of the disease.
In conclusion, early diagnosis and intervention in Alzheimer’s disease are crucial for managing the condition and slowing cognitive decline. The promising results from studies on donanemab and Leqembi offer hope for effective treatments, although further research is needed to determine their long-term benefits and safety. Additionally, efforts should be made to ensure that clinical trials are diverse and representative to ensure equitable access to potential treatments.
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