Researchers highlighted the complexities of using amyloid immunotherapy for early Alzheimer's disease, discussing its clinical benefits, challenges, and broader health implications. Despite some positive results, concerns over adverse effects, trial biases, and cost hinder widespread adoption.
By Dr. Chinta SidharthanReviewed by Susha Cheriyedath, M.Sc.Aug 7 2024 In a recent perspective piece published in the Alzheimer's Association's journal Alzheimer's & Dementia , researchers from the United Kingdom and the Netherlands examined the pros, cons, and challenges associated with the use of amyloid immunotherapy drugs for treating early Alzheimer's disease from the clinical lens and the perspectives of health systems and population health.
The two phase III trials for the amyloid immunotherapy drugs donanemab and lecanemab have reported that compared to the placebo, the drugs have been successful in lowering the rate of functional and cognitive decline. However, the observed effect sizes are well below the minimum threshold for clinical importance.
Individuals carrying the apolipoprotein E4 allele who were at higher risk of Alzheimer's disease also showed greater rates of adverse reactions and lower treatment response rates, indicating that genetic testing is necessary before amyloid immunotherapy is recommended as a treatment option. The exclusion of Alzheimer's disease patients with comorbidities and co-neuropathies meant that to maximize efficacy, these phase III trials focused on a highly homogeneous group, making the findings difficult to generalize to the broader population of Alzheimer's disease patients. The exclusion of patients with mixed dementia pathologies also impacted the applicability of the findings to the general patient population.
Perspectives from healthcare The researchers discussed the amyloid immunotherapy drugs that have currently been approved for clinical use and the reception of these drugs among the Alzheimer's disease patient population. The current FDA-approved drugs include aducanumab, lecanemab, and donanemab.
Immunotherapy Allele Antibodies Brain CLARITY Dementia Drugs Efficacy Food Genetic Health Systems Healthcare Imaging Placebo Protein
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