Aducanumab - What is the truth behind the new dementia ‘miracle drug’?
You might have seen reports in the media about Aducanumab, a new drug to treat Alzheimer’s. It is the first new treatment developed to combat the disease in 20 years. It was approved for use in the USA this month (June 2021), putting pressure on countries worldwide to make it available, despite some controversy and mixed evidence on it’s efficacy.
But what is it? who does it help? And does it really work? Recognii reports.
What is Aducanumab?
Aducanumab is a new drug created to target the build-up of amyloid protein plaques in the brain (a ‘sticky’ substance that collects between the neurons and disrupts normal functioning) and clear them away. Amyloid protein plaques are believed to be the main cause of Alzheimer’s disease and most drugs that are designed for the disease have attempted to clear these.
Why is it controversial?
Aducanumab is the first drug to be approved in the USA that acts on the disease itself, rather than just relieving symptoms. Other drugs, such as Aricept, have been approved because they help with symptoms, but do not stop the underlying disease. Some scientists are concerned that this means Aducanumab may not actually enhance the lives of many people living with Alzheimer’s, because simply removing the plaques may not improve cognitive function enough.
Will it be available in the UK?
It has not been approved by NICE (the body responsible for making it available via the NHS) yet. NICE is conducting its own research and deciding whether the drug is beneficial and cost effective, but this may take many months. It will also have consequences for the NHS if it becomes widely available. Patients will require PET scans to see if they are suitable candidates for the treatment and, staff to administer them, which may not prove cost effective in the long run.
How is it administered?
Aducanumab is not a pill that can be taken at home. It is an infusion (liquid injected directly into a patient’s arm on a drip) that is administered by a doctor in a clinic for one hour every four weeks.
Are there any side effects?
Researchers report a risk of swelling and abnormal bleeding in the brain, headaches, balance problems leading to falls, disorientation and stomach issues including diarrhoea.
Does it work?
Aducanumab does appear to reduce amyloid plaques in some patients, but only at an early stage according to researchers. This means that people will have to be tested at the first signs of memory loss to benefit from the treatment. Aducanumab is only designed to help certain people with mild cognitive impairment and early disease. Research suggests that it does improve general thinking ability and orientation and language problems, such as losing track of time and place and not being able to name well-known objects, such as keys or a clock. However, even though it has been approved in the US, it is on the condition that doctors still monitor patients’ progress to see if it really does halt mental decline in the wider population. If it doesn’t, the drug will be taken off the market.
So what is all the fuss about?
Even though the benefits of Aducanumab may only be modest, the clinical trial results and approval in the US have sparked a debate about how regulators judge the effectiveness of any new Alzheimer’s treatment. Aducanumab’s approval is based on biological markers – reducing plaques - rather than proof that it relieves symptoms. It may mean that companies prioritise investment in and development of other drugs for Alzheimer’s and dementia that simply reduce amyloid plaques. Scientists are divided as to whether this will help or hinder the development of truly effective treatments which improve quality of life for Alzheimer’s patients.
What is available now?
Existing Alzheimer’s drugs like Aricept can help people day to day by stabilising memory loss. Unfortunately, they don’t work for everyone and over time their effects wear off. They can be very beneficial in the short-term though, improving cognition and function and provide a temporary reprieve from the disease.
Is there any sign of a cure at all?
There are currently 126 drugs across more than 150 clinical trials being trialled for Alzheimer’s disease worldwide with many more in the pipeline. Doctors and scientists are hopeful of real progress in the next five to 10 years.