2023-09-21 09:52:40
Today is World Alzheimer’s Day, the most common form of progressively disabling degenerative dementia. There is still no therapy but various molecules have sought prominence in recent years. Opening up some hope for patients and families. Taking stock is Paolo M. Rossini, director of the Neuroscience and Neurorehabilitation Department of the Irccs San Raffaele in Rome. “We ended 2022 with a bit of a bitter taste in the mouth for patients, families and professionals linked to the fact that the first drug that had demonstrated some effectiveness in modifying the natural progression of the disease approved in the USA (Aducanumab*) did not it was then approved in Europe (and therefore in none of the EU countries) due to a series of reasons that are mostly agreeable – he observes – such as the poor clinical efficacy, the relatively frequent and sometimes alarming side effects, the high direct costs and indirect (including organizational ones for hospital provision and monitoring of side effects)”.
2023 “opened with the approval by the FDA of another monoclonal antibody against beta-amyloid (such as Aducanumab) whose approval process is now under the attention of the authorities of the European Medicines Agency. The molecule it’s called Lecanumab*; in this case the efficacy seems greater, the side effects much lower, while the problems relating to direct and indirect costs remain unresolved”, continues Rossini.
“As expected, once the door was opened by Aducanumab, we would have witnessed a progressive entry of new molecules that are capable of slowing down the evolution of the disease. In fact, there are several drugs waiting to finish their Phase III which – if corroborated from positive results – then allows the request to be placed on the market; some of these can be administered subcutaneously (such as insulin for diabetes) and would therefore not require an onerous and expensive hospital distribution phase such as that required to carry out an IV. It seems useful to me to point out the one with Valitramilprosate* – underlines Rossini – because it would be the first formulation that can be taken orally, because it would act not only on beta-amyloid, but also on tau (another ‘killer’ underlying the formation of neurofibrillary tangles in inside the neurons attacked by neurodegenerative processes), would have very few side effects of little importance and would appear to be able to block the evolution of the disease. The use of many conditionals is a must – he specifies – since all the information available up to now comes from the manufacturing company and therefore requires an in-depth evaluation by a neutral committee as soon as the same company has to open its archives to show the original data in order to begin an approval process”.
And what do we do now? “There are the usual ‘symptomatic’ drugs with all the well-known limitations – replies the neurologist – there is the focus on lifestyle (the scientific evidence supporting the fact that doing gymnastics every day is increasingly solid and dedicating time to cognitive activities increases the resistance of surviving neurons and nervous circuits) and on the risk factors to be reduced or eliminated completely (obesity, smoking, excess alcohol, diabetes control, blood pressure control, heart disease control)
“Finally, treatment hypotheses are emerging that we currently still have to consider experimental in which various types of energies are used (pulsating magnetic fields, low intensity electric currents, focused ultrasound, shock waves) capable of selectively activating (the stimulation probes are guided by the images of the brain of that particular patient via neuronavigation techniques) making the energy in use impact on the brain ‘control units’ which are particularly important for memory, orientation, language, mood etc. It seems that daily sessions lasting a few tens of minutes, repeated from Monday to Friday for 3 or 4 consecutive weeks are able to maintain or even improve the functions connected to the stimulated circuits for the following 6-12 months”, he concludes.
#Today #World #Alzheimers #Day #therapies