2023-09-21 08:44:20
Experts and patients agree that 2023 could be a turning point in research against pathology; The reasons for hope against Alzheimer’s? the drug lecanemabalready approved by the United States Food and Drug Administration (FDA, in English) and the donatemabwhose good data were presented last July at the International Alzheimer’s Conference in Amsterdam.
“Alzheimer’s is a complex problem and there will probably be no simple solutions. As with other diseases, such as AIDS, it will not be a single medicine but rather a cocktail,” he predicts. in statements to EFE, the secretary of the Behavior and Dementia study group of the Spanish Society of Neurology (SEN), Pascual Sanchez.
plaque disease
The disease, of which Every September 21st, World Day is commemorated.is characterized by the accumulation in the brain of two types of proteins: one of them is beta-Amyloid, which folds poorly and accumulates outside the cells, forming a kind of plaques; and the other is the yeswhich also folds poorly and is stored forming structures called neurofibrillary tangles inside the neurons.
EFE/Luis Tejido-jr
To diagnose Alzheimer’s disease, the brain must suffer these two lesions.
“What we call Alzheimer’s dementia is when, accompanied by these lesions, the brain, so to speak, gives up and there begins to be neuronal death, atrophy, and this is expressed with the cognitive symptoms that we know in the disease. The earliest are memory problems,” says Sánchez, who is also scientific director of the Cien Foundation, -Research Center for Neurological Diseases of the Carlos III Health Institute-.
Currently there are symptomatic treatments, which do not change the course of the disease but help people “in some way have better cognitive performance.”
For this reason, experts are eager to have tools that can change the progression of injuries and have hope against Alzheimer’s.
What do the new drugs do?
This year they have entered the scene, first lecanemab, already approved in the United States (not yet in Europe). A drug that slows the effects of neurodegenerative disease. In the latest study, conducted on 1,800 patients, it demonstrated a “significant reduction” in cognitive impairment, according to the FDA.
And the second, also promising, is donanemab, with “robust” results, says Sánchez.
The expert Pascual Sánchez. Photo provided by the SEN. © Raúl Lucio
“What they do is remove Amyloid, that protein that accumulates in the brain. They are monoclonal antibodies, which stick to that protein. First they have to pass the blood-brain barrier – the brain is isolated from the blood – and very little of that drug passes and binds to the Amyloid plaques and activates the immune system to eliminate them,” explains the SEN expert.
Both show, with 18-month results, that they delay cognitive deterioration compared to patients who have not tried it.
Positive results will have to be demonstrated beyond 18 months of administration but it seems that they do change the course of the disease in early phases. “This is what we were looking for after more than 20 years without positive results, of failures in clinical trials,” says Sánchez.
It is not that these drugs are the solution “far from it”. The results “are modest but robust”, which gives rise to hope against Alzheimer’s because with them a barrier has been broken that shows that there is a possibility of changing the biology of the disease. A path, adds the expert, that has already been followed before in other diseases such as cancer.
Side effects
These therapies are not free of side effects. According to the SEN expert, trials have shown that a percentage of patients suffer from inflammation in the brain, but the majority have mild symptoms.
Around 2% have had more serious symptoms, but they are patients who have a certain “genetic background”, which is why it has been considered whether or not it is too risky to administer it to certain patients with that genotype.
“All drugs have adverse effects and this ultimately depends on the regulatory agencies to balance the risk-benefit,” adds the neurologist.
“A turning point” and hope for Alzheimer’s patients
For the Spanish Alzheimer’s Confederation (Ceafa) That the FDA has approved a drug, that it can reach Europe and that another has been presented with good results is “a point of inflection and hope.”
“Although it will not be able to reach all patients, it will be able to reach a percentage of those who are diagnosed early. That is, after 20 years without anything, a little bit of light,” she says, in statements to EFE, at the president de Ceafa, Marilo Almagro.
Mariló Almagro. Photo provided by Ceafa.
Almagro celebrates that a lot of research has been carried out because it allows us to have more hope for a possible cure for Alzheimer’s.
Also, Spain is one of the countries that does the most research in this sense, in fact, according to the report “Spain on the world map of scientific production in dementia and Alzheimer’s”, promoted by the Pascual Maragall Foundation, the country occupies sixth place .
However, the president of Ceafa regrets “the precariousness with which Spanish researchers work and that they are not adequately financially supported.”
Non-pharmacological therapies
Almagro also emphasizes the importance of non-pharmacological therapies to help patients such as cognitive and functional rehabilitation, physical therapy and, among others, also animal-assisted therapy. All of them adapted to each level of ability that the patient has.
Ceafa has requested the Ministry of Health to include this type of therapies in the Portfolio of common services of the National Health System, but, for now, the Ministry has asked for scientific evidence.
“In Health they have told us that in Spain these therapies are not validated. That is why at Ceafa we are doing it with the state Alzheimer’s reference center and with the University of Salamanca so that, with a scientific method, we can return to the Ministry and have them validated,” explains Almagro.
“I have Alzheimer’s but I’m still me”
And to vindicate the role of patients and that when they are diagnosed they can continue doing things, Ceafa has presented the documentary “I have Alzheimer’s but I am still me.”
Image from Ceafa’s documentary.
“That’s what this documentary is about, I have Alzheimer’s, but I’m still me until the end. And it is said about patients who have Alzheimer’s, a family member speaks for them in different everyday situations. Well no, as long as he can talk, he has to talk. It is giving another vision to the disease,” says Mariló Almagro.
Among the claims of neck For World Alzheimer’s Day it is also found that there is a census of patients, since it does not exist.
According to SEN, Every year, around 400,000 new cases of Alzheimer’s are diagnosed in Spain.. In more than 65% of cases, in women, and in 90% in people over 65 years of age.
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