Understanding treatment pathways for Alzheimer’s Disease

In the realm of neurological disorders, Alzheimer’s Disease (AD) stands as one of the most challenging and devastating conditions of our time. With its progressive nature and profound impact on memory, cognition, and daily functioning, AD poses significant hurdles for both patients and their loved ones. As the global population ages, the prevalence of this disease continues to rise, further emphasizing the pressing need for effective treatment pathways.

This blog looks at all the factors that must be considered when determining a treatment pathway for patients, as well as the drugs used to treat those with AD.

So when making decisions about AD treatment, there are several important factors to be considered – is there sufficient support for the patient and caregiver, are there any adjustments for the environment needed including where they live, and who can support them during the treatment , are there any changes needed to the patient’s lifestyle, as well as addressing risk-factors of the treatment and providing AD-specific medications.

 

Current drugs used to treat AD

AD-specific medications include drugs which target brain neurotransmitter imbalance – these include choline esterase inhibitors (ChEi) and NMDA-receptor antagonists used both individually and in combination and are approved for the treatment of patients with established dementia.

In the past two years, the FDA has granted an approval, under an accelerated process, for two medications, which are based on antibodies to beta-amyloid, which is a toxic substance that accumulates in the brain of patients with AD. These treatments have received approval under an accelerated process.
These drugs were tested in large studies and initial analysis showed that patients that were on treatment deteriorated less than those on placebo. But these treatments are associated with amyloid-related imaging abnormalities (ARIA) in the form of brain edema and hemorrhage, and in rare cases, an increased risk of mortality.

On July 6, one of these medications, lecanemab (Lequembi) has received final approval from the FDA for the treatment of patients with mild cognitive impairment (MCI) and mild dementia. But before administration, patients should be tested for their ApoE status as the subtype ApoE4 is linked to a higher risk of ARIA. In addition, administration of lecanemab to patients who are receiving anticoagulation is also associated with an increased risk for ARIA in the form of brain hemorrhage
. Data from a large clinical trial with another medication of the same class, is very promising, with the expectation that it will also be approved soon.