The Lancet: Experts outline healthcare, policy, and social changes needed to make the most of Alzheimer’s treatment breakthroughs

(Press-News.org) The approval of new antibody medications for Alzheimer's disease – lecanemab and donanemab – and diagnostic tests in the blood mark the beginning of a new era in Alzheimer's disease diagnosis and treatment. However, without rapid reform in healthcare systems, public policy, and societal attitudes, their potential will not be fully realised, argue 40 leading Alzheimer's disease experts in The Lancet Series on Alzheimer's disease.

Alzheimer's disease accounts for about 70% of all dementia cases and is a leading cause of disability, resulting in high societal and economic costs.

In a novel comparison, the Series highlights that the new monoclonal antibody treatments can slow Alzheimer's disease progression to a level comparable to the efficacy of medicines for cancer, rheumatoid arthritis and multiple sclerosis. However, the authors say that differences in age, patient outcomes, and side effects mean such comparisons should be treated cautiously.

Disease 

Alzheimer’s (Lecanemab) 

Alzheimer’s (Donanemab) 

Early stage breast cancer 

Lung cancer 

Multiple sclerosis 

Rheumatoid arthritis 

Efficacy in delaying progression 

8% 

10% 

9% 

32% 

4% 

n/a 

Reduction in progression on disability scales  

0.19 

0.26 

n/a 

 

n/a 

 

0.20 

0.25 

For a more detailed comparison see table 2, page 8 in the third paper ‘Alzheimer's disease outlook: controversies and future directions’ 

Despite the similarity in treatment effectiveness for other diseases, high costs of medication, complex testing requirements, suboptimal care for behavioural symptoms, and under-resourcing risk leaving Alzheimer’s patients behind. 

Encouragingly, improvements in the prevention of Alzheimer's disease are also on the horizon, with emerging Brain Health Services identifying people at a high risk for developing the disease and providing them with personalised treatment programs. Yet most cases of Alzheimer's disease occur in people with low or normal risk, making population-wide measures, which decrease risk – such as healthier urban design and restrictions on alcohol and sugary drinks – essential. 

The authors call for coordinated global action so that the rapid pace of science advancement in the field of Alzheimer's disease is matched by reforms at the level of healthcare providers, policy, and society.  

Lead author of the Series, Professor Giovanni Frisoni, University of Geneva (Switzerland), says: “Blood tests, biological drugs for Alzheimer's disease, and prevention interventions are propelling care into entirely new and exciting territory. However, the old needs of patients will not disappear. On the contrary, more general practitioners and dementia specialists will need to master the less glamorous but steady advances made in the past few decades in the care and treatment of behavioural disorders, the use of sophisticated diagnostic imaging and laboratory tools, and psychosocial care. A concerted societal effort in this direction will enable our current and future patients to benefit fully from the potential of scientific and technological advances.” 

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