Should new Alzheimer’s medications be prescribed? Our expert’s opinion

in collaboration with

Dr Christophe de Jaeger (Longevity and geriatrics)

The mechanisms of Alzheimer’s disease are still very unclear. However, research is progressing slowly and two promising drugs have recently been developed against the disease. However, due to the risks they present, some doctors are still hesitant to prescribe them to their patients.

Lecanemab and donanemab, two antibodies against amyloid plaques

The two molecules, lecanemab and donanemab, are two antibodies directed against beta-amyloid proteins, responsible for the plaques bearing the same name, which gradually colonize the brains of patients, triggering their cognitive disorders.

Injecting one or other of these drugs would therefore make it possible to reduce these amyloid plaques, but also to slow the progression of the disease. According to studies, they improve the condition of patients by extending their healthy life by approximately 4 to 6 months.

A higher number of deaths, according to the latest data

If these two molecules bring hope for all Alzheimer’s patients, they would not represent a miraculous treatment either. According to the Daily Maillecanemab was found to triple the risk of death within one year, compared to people with dementia who were not prescribed the drug.

Indeed, this study – which is based on American data on drugs used since last year – revealed that the risk of death was significantly higher than that reported in clinical trials: 21 deaths were recorded, out of 10,000 patients taking lecanemab.

Medicines that are not funded due to lack of a positive benefit-risk balance

On July 26, theEuropean Medicines Agency (EMA) has refused the marketing of Leqembi (lecanemab) for the treatment of early-stage Alzheimer’s disease in Europe. On July 3, the American authorities gave the green light for the marketing of this drug. The reasons given then by the European agency were a weak effect on the score of tests assessing cognitive abilities, potentially serious side effects and a higher risk of complications for certain genetic forms (notably ApoE4). All the details of this decision and the reactions of the associations in our article “Alzheimer: Europe blocks a highly anticipated treatment authorized in the USA”.

England’s National Health Service (NHS) spending watchdog also refused to reimburse the drug, arguing that it offers “relatively modest benefits […] which means it cannot be considered good value for money“. However, it remains accessible to patients, for the modest sum of 20,000 pounds, or more than 23,000 euros. The same organization also rejected the request for donanemab.

A significant risk of hemorrhages and cerebral edema

In total, 3,000 patients have started taking this type of molecule in the United States, since their approval by the American health authorities in July 2023. But patients taking these drugs also run an increased risk of edema and bleeding. potentially fatal brain injuries.

According to Robert Howard, one of the study’s authors, an expert in old-age psychiatry at University College London, “The idea that lecanemab is a miracle drug is not supported by trial evidence. It is even doubtful to say that these drugs slow the progression of the disease, because this is only an interpretation”.

Before warning: “Anyone who has the money to afford lecanémab needs to think carefully about it, because the risks are real.”.

Should these medications be prescribed to patients affected by Alzheimer’s?

Questioned on the subject, Dr. Christophe de Jaeger, physiologist and member of the Doctissimo expert committee, remains cautious. “In reality, we do not know enough about the effectiveness of these molecules in the long term. he thinks first of all. “The question is whether it can provide a real benefit to patients, knowing that the risk will always exist“.

How is the prescription of this type of molecules carried out in France? According to our expert, it does not exist in the private sector. “At the hospital, doctors discuss in committee whether or not it is appropriate to inject this treatment into a patient.” he adds. “In the United States, the patient and their family will even have to sign consent before being prescribed the medication. But if the benefit is only 6 months, it is difficult to make a patient take risks for such a short period of time.” he concedes again.

For our expert, we must therefore be patient. “We must wait for the results of additional studies on these molecules, so that we can have more solid data which will make it possible to prescribe this type of molecules in the most appropriate way possible to patients who need them.”.

Slide: Seven lifestyle habits that reduce the risk of dementia