What you need to know about Alzheimer's disease drugs

For the first time in history, doctors treating patients with Alzheimer's disease now have access to two drugs that may be able to slow the progression of the disease to some extent, at least in some patients.

The two drugs, Leqembi (lecanemab) and Kisunla (donanemab), are “transformative,” said Paul E. Schulz, MD, professor of neurology and director of the Center for Neurocognitive Disorders at McGovern Medical School at UTHealth Houston. “They give us the first hint that we are on the right path, and it gives us great hope that we can continue to fine-tune and improve effectiveness.”

One day, this drug, or its next generation, could completely prevent cognitive decline in people who show signs of the disease in their brains but don't yet have symptoms, say researchers at the Department of Cognitive and Behavioral Neurology in Boston, Virginia. Lead author and university professor Andrew Budson, M.D., predicts: Boston University Neurology. “These drugs are an absolute breakthrough for today's patients, but even more so for tomorrow's patients,” he says.

But even with all the excitement and potential, serious consideration should be given to these drugs. Side effects may occur and may be serious or even fatal. Additionally, these drugs are expensive, with a list price of more than $25,000 per year.

So it's no wonder that people newly diagnosed with Alzheimer's disease have questions. People with certain risk factors are told to “talk to your doctor.” But do most doctors have an answer?

“In my experience, most neurologists haven't had the opportunity to learn about this area of ​​therapy,” says Schultz, one of the researchers who studied Kisunra in clinical trials. “We're in a learning curve right now.”

AARP interviewed six leading Alzheimer's disease experts to get answers to 15 questions about new Alzheimer's disease drugs.

1. How do these two drugs work?

Leqembi and Kisunla are antibodies that bind to amyloid proteins within Alzheimer's disease plaques. These plaques are formed from naturally occurring proteins that accumulate in the brain and cause problems. Most antibodies in the body are made by the immune system to fight off infections from viruses and bacteria, and these two are produced in the laboratory. When antibodies attach to amyloid molecules, the body's immune system is alerted to destroy the amyloid, potentially removing it from the brain and slowing the progression of the disease.

2. How is this drug different from existing Alzheimer's disease drugs?

Other Alzheimer's drugs are also effective reduce symptoms Alzheimer's disease-like memory loss and confusion due to changes in brain chemistry. They are given as tablets. These two drugs are administered by intravenous infusion.

3. What are the differences between them?

Rekenbi binds to small molecules of amyloid called “amyloid protofibrils.” Kisunla binds to the amyloid plaque itself. “It's not clear whether these different binding targets are important,” Budson says. Budson said Requemby is given every two weeks for 18 months and every four weeks thereafter, adding: “There is no clear guidance on when to stop.” Kisunla is given every four weeks until amyloid is cleared, as measured by scans. Treatment is stopped if the PET scan shows minimal levels of amyloid.

4. What are the side effects? Are they serious?

Symptoms similar to the flu, such as chills, shortness of breath, and a rash, can occur, but they are generally mild and can be treated with over-the-counter antihistamines such as acetaminophen and Benadryl, according to a geriatrician at a national hospital. says Professor Jason Karawish, MD. He is a professor at the Perelman School of Medicine at the University of Pennsylvania and co-director of the Penn Memory Center. But of greater concern is when amyloid-related imaging abnormalities, known as ARIA, occur, which include swelling and/or bleeding in the brain. “ARIA can be mild, moderate, or severe,” Budson says. “In severe cases, it can lead to serious, life-threatening conditions.”

Patients taking Kisunla experienced more ARIA than those taking Leqembi, but the researchers noted that the two drugs were not compared to each other in the study. In addition, “Donamab” [Kisunla] the patient was further advanced [in the disease] Cognitively and biologically, and so many of us believe this is why donanemab has more ARIA,” says Schulz.

“I have a lot of patients who are on each drug, and I feel confident that I'm doing them a favor with each drug. I'm also confident that I'm not putting one group at greater risk than the other.” “It's not like we're doing it right,” Schultz added.

Geriatrician Mia Yang, M.D., Associate Professor of Internal Medicine, Division of Gerontology and Geriatrics, Wake Forest School of Medicine; print article from Annual report of internal medicine When discussing a new drug, she points out to her patients that the drug is dangerous for patients with medical conditions that make them more likely to have a heart attack, ischemic stroke, or blood clots in the legs or lungs within the next year or two. did. year. “During the trial, the most deaths occurred in patients who received additional blood thinners,” she wrote in an email.