introduction
Aducanumab (Aduhelm)
Lecanamab
Monoclonal Antibody (hence the Mab) treatments are being hailed as the holy grail of Alzheimer's treatments.
But what do these treatments actually DO?
How effective are they?
And what do they cost?
Well. I'm just a layman interested in dementia (a self-interest), so my research is necessarily superficial, and I may have made some false assumptions.
So please feel free to correct, berate, and educate me if I state incorrect things.
What ARE Monoclonal Antibody treatments?
A protein known as beta-amyloid begins to build up in the brain. We all produce it, but for some reason (genetic, ageing etc.) some people (like me) lack the ability to clear out the excess, which then forms clumps in the brain known as plaques.
As these plaques proliferate, another protein called TAU, which is found inside the neurons, also starts to stick together and tangle, spreading through the brain and disrupting normal nerve function. And sometimes also building up in the brain's blood vessels, making them stiffer and less able to carry blood and nutrients to the cells. That can prevent the brain from getting enough glucose.
The result? The brain doesn't get the energy it needs. In addition, there is often associated inflammation.
Now, if you read the rash of recent articles on the subject, you might believe that Monoclonal Antibody treatments are a panacea for Alzheimer's disease. The treatment for which we've all been waiting. And that the day has finally arrived when memory loss can be effectively halted in its tracks, First past the post was aducanumab (marketed as Aduhelm), conditionally approved for use in the USA by the Federal Drugs Agency (FDA) in June 2021; the appearance of Aducanumab was significant because it was the first drug designed to target the amyloid protein build-ups in the brains of people with early stages of Alzheimer's disease. There are now over 100 different compound drugs in clinical trials taking place worldwide.
When you consider that around 55 million people are living with dementia worldwide and that that number will TRIPLE by 2050, it doesn't take a rocket scientist to see that the money to be made from a successful drug is staggering.
How effective are they?
They're potentially a game changer, but the jury seems to be out on whether the current batch of Monoclonal Antibody treatments are safe and effective.
I was prompted to write this article after reading a spate of rosy reviews of the latest research that implied that the fight to produce a viable product is all but over. Reading around the subject, though, this appears to be far from the case. While there is no doubt that these treatments reduce the amount of amyloid in the brain, they fail to show much, if any, cognitive benefit.
Indeed, there is evidence in the trials carried out so far that these treatments may trigger amyloid-related imaging abnormalities, including cerebral oedema (35% of treated patients) and cerebral haemorrhage (21% of treated patients). In addition, in some patients, these changes were associated with headache (47%), confusion (15%), dizziness (11%), and nausea (8%).
And what do they cost?
Aducanumab is delivered via an infusion — directly into the vein through a needle or catheter — once a month. The length of each infusion appointment varies from 1 to 3 hours. Aducanumab must be administered over the long term (at least a year). This procedure must be carried out by a medical professional.
As you can imagine, this is expensive. Biogen, the makers of Aducanumab, estimate that the cost of the drug will be around $56,000 per annum!
I cannot see many insurance companies being pleased with this, and the chances of getting the treatment on the National Health Service (NHS) will be vanishingly small.
Conclusion
These drugs are not designed for people at my stage of the journey into dementia. So I'll stick with the cholinesterase inhibitor-type drugs like Donepezil or Galantamine, which improve mental function (such as memory, attention, the ability to interact with others, speak, think clearly, and perform regular daily activities) by increasing the amount of naturally occurring substances in the brain.
Perhaps I'm misinformed or merely a cynic.
Please let me know your thoughts.