August 2023 Alzheimer's Treatment Update

The medical staff at Memory and Movement Charlotte is dedicated to the diagnosis, treatment, and overall management of Alzheimer’s disease. Our patients and their families remain our absolute priority.

No two patients are alike, and we prescribe treatments on an individual basis.  As new therapeutics become available, we are committed to understanding the potential benefits and side effects of these treatments. The news has been full of announcements of new and emerging therapeutics and our practice will continue to report our opinions of these therapies to our patients and their families.

For over three decades there had been no progress in the medical treatment of Alzheimer’s disease. Medications have been limited to cognitive enhancing drugs such as donepezil and rivastigmine that have had limited efficacy in treating symptoms and have had no impact on the disease itself such as slowing the progression of symptoms.

Scientists have long searched for targets within the brains of people with Alzheimer’s disease that could be altered or repaired in hopes of stopping the disease or significantly slowing the progression of symptoms and the resultant loss of independence.

Amyloid plaque accumulation in the brains of Alzheimer’s patients has been the prevailing target for therapeutic investigation for most of those three decades and has attracted significant research funding, for a time limiting other research. We now feel the “amyloid theory” has been settled. This target is only part of the answer. The many drugs that have successfully removed amyloid plaques from the human brain have either delivered no discernable benefit or only modest slowing of symptom progression. The door is now open for more research into other promising targets such as tau.

There are now two approved anti-amyloid therapies for Alzheimer’s disease, both having received initial FDA approval, known as accelerated approval, because they effectively remove amyloid plaque formation. Aduhelm (generic name aducanumab) has not received full approval due to a lack of proven clinical benefit. Leqembi (generic name lecanemab) recently received full approval for modest slowing of progression. This modest slowing is a statistically significant benefit over placebo in the research studies, but most clinicians feel it would not be clinically meaningful to the Alzheimer’s individual. Additionally, potential side effects must be considered and these include bleeding and swelling in the brain, with a minority of patients suffering stroke symptoms. Our practice has previously announced our opinion that Leqembi does not provide sufficient clinical benefit, especially as we consider the potential side effects, to support the use of this medication for Alzheimer’s disease. With full approval Leqembi will be covered by insurance companies, thus removing a financial obstacle. But the very limited efficacy unfortunately fails to outweigh the chance of serious side effects.

A new drug the FDA will soon review is donanemab. Our practice is reviewing the final research results with cautious optimism. The initial information suggests a more significant slowing of the progression of symptoms that may balance out the risk of bleeding and swelling, a risk this drug shares with Leqembi. We predict the FDA will fully approve donanemab within the next few months and it will likely be available by the end of this year or early next year. We share the concern of our patients and families that time should not be wasted, and we hope for prompt approval and availability. It will only be beneficial for those with early symptoms of Alzheimer’s disease, and it is predicted to slow progression rather than reverse symptoms.

As our practice learns more details about donanemab we will discuss them during patient visits and send out ongoing updates for your review. Let us all continue to hope for improved treatments as we work together to fight Alzheimer’s disease.

Dr. Aris Chaconas has been a neurologist for 30 years and has been with MMC since 2017. He spent four years as Regional Director of Neuroscience for Pfizer and brings a unique perspective from the pharmaceutical field to the practice.

Podcast featuring Dr. Chaconas(1)