New Alzheimer’s drugs bring hope of slowing disease for UK patients

People in Britain could benefit from a major medical breakthrough next year. They may have access to the first drugs ever developed to slow the effects of Alzheimer's disease.

The first of these drugs – lecanemab – was recently approved in the US and Japan, where treatments using it have already been launched. A second drug, donanemab, is expected to follow soon, and next year British medical authorities are expected to consider both drugs for approval in Britain.

The prospect has raised hopes that, after years of effort, scientists are getting closer to finding ways to directly tackle Britain's dementia crisis. Around a million people in this country live with the condition, and this number is expected to rise to around 1.7 million by 2040 – with potentially grim consequences. Last year, dementia claimed the lives of 66,000 people in England and Wales, and it is now the leading cause of death in Britain, with Alzheimer's disease responsible for two-thirds of cases.

Until now, doctors have only been able to prescribe drugs that help patients control their symptoms, so the arrival of the first drugs that treat the real cause of the condition has been welcomed – although experts have warned that their use should be used with some caution treated.

“The new drugs slow the progression of Alzheimer's disease by six months to a year and are only useful for people in the early stages of the disease, so they are certainly not miracle drugs,” said David Thomas, head of policy at Alzheimer's Research UK. .

“However, after decades of research, they are the first to directly improve patients' lives, and that is a reason for excitement. If nothing else, they suggest that we are probably on the right track to tackling Alzheimer's disease.”

This point was supported by neurologist Cath Mummery from the Dementia Research Center at University College London. “It's been a very long, difficult road, but finally we have something positive to look at. That is very welcome.”

Alzheimer's disease is caused by the buildup of a protein called amyloid in the brain, although symptoms may not appear until decades after this buildup begins. Scientists have been trying for more than two decades to find ways to prevent amyloid from forming these plaques, in the hope that it would halt the progression of the disease.

Lecanemab, produced by Japanese pharmaceutical company Eisai, and donanemab, produced by Eli Lilly of the US, are the first drugs to achieve this goal – although they only slow but ultimately do not stop the progression of the disease.

Both drugs will be considered for approval in Britain next year. The Medicines & Healthcare products Regulatory Agency (MHRA) will first decide whether they are safe and effective, and then the National Institute for Health and Care Excellence (Nice) will decide whether they offer value for money.

Both drugs are expensive – lecanemab costs about €25,000 a year – and are administered via regular intravenous infusions. “That's a challenge from a healthcare perspective because you have to find the space and time to put someone in an infusion suite to treat them,” Thomas said.

However, the biggest problem that doctors face is the difficulty associated with diagnosing dementia, not only in the early stages, but even in the later stages. Most cases are first presented to general practitioners, who then refer patients to memory clinics for a dementia test. However, there are long waiting times – up to two years on average – for appointments at these centers.

Furthermore, the diagnosis of Alzheimer's disease and other forms of dementia is usually based on pen-and-paper tests, followed by lumbar punctures and brain scans before a final diagnosis is made.

About 65% of cases are confirmed this way. The remaining third of dementia cases are never diagnosed. Yet patients can only expect treatments – including the new drugs – if their condition is diagnosed.

Eleanor Mackenzie-Smith's father, Mike, has early-onset Alzheimer's disease. His first symptoms were noticed 17 years ago, when Eleanor was 11. “However, it took more than 10 years from the onset of his symptoms and four separate tests between 2009 and 2017 to receive my father's final diagnosis, when he was 65. disturbing because I didn't know what was going on. Too many families, like mine, have had to watch dementia take hold of our loved ones, leaving us undiagnosed and without support and access to treatment.”

Another stark illustration of the problem patients face is given by Graeme Armstrong. In 2006, his wife Trina started having trouble recognizing faces and reading phone numbers. Three years later, after a CT scan, she was told she had probably had a stroke – although her symptoms did not indicate such a diagnosis. It took another three years before she was diagnosed with posterior cortical atrophy, a rare variant of Alzheimer's disease that affects the way the brain interprets information from the eyes.

“If we had had an accurate diagnosis four years earlier, Trina could have been put on the right medication, which might have been more effective and helped her day to day,” Armstrong said.

One solution doctors are looking for is setting up blood tests that can quickly and effectively detect the disease. “Research is being done into this, but it will take a number of years before we use them on a large scale,” says Thomas. “In the meantime, we need to get the NHS to a state where it is much more focused and organized in getting better and earlier dementia diagnoses. This will be crucial in our fight against the disease.”

Mummery agreed: “By the time you get dementia, you've had Alzheimer's in your brain for at least 20 years. Dementia is the final stage; we need to pick up signals much earlier. So we need to think about how to diagnose people in the very early stages of the disease, when they may only have very subtle symptoms.

“Our current services are not fit for purpose, and we need to develop brain clinics where we can detect the disease much earlier and then help build resilience to dementia in a patient when it is in its very early stages. ”

In the long term, scientists also point to a number of recent developments that have raised hopes that it will be possible to tackle dementia more directly and effectively. One major challenge they have faced is the problem of getting drugs through the blood-brain barrier, which controls the movement of ions and molecules from our bodies to our brains. That makes it difficult to get drugs into the central nervous system to address problems like amyloid plaques.

“However, researchers are developing active transport methods to get drugs across the blood-brain barrier,” says Mummery. “For example, we are now investigating ways to get medicines to the brain much more efficiently, and that could have a major impact.”

It will take years for such developments to materialise, scientists warn, and much remains to be done in the short term to tackle dementia.

“Clearly we have taken a step in the right direction, but much more needs to be done before we can successfully deal with these processes happening in our brains,” said Thomas. “It is a challenge, and a very important one.”