Balancing the risk and benefits of new Alzheimer’s drug

(Stat News) “How does one balance some of the logistical and possible efficacy benefits of donanemab against the doubling of ARIA? I don’t have an answer,” he told STAT’s Adam Feuerstein. Is the cure worse than the disease?

The buildup of plaque in the brain is a hallmark of Alzheimer’s disease, but it is not the only cause. Many factors likely contribute to the development of Alzheimer’s, including genetics, lifestyle, and environmental factors.

Plaques are made up of a protein called amyloid beta. Amyloid beta is a naturally occurring protein, but it can clump together to form plaques in the brain. These plaques are thought to disrupt the normal function of brain cells, leading to cognitive decline and dementia.

However, not everyone with plaques in their brain will develop Alzheimer’s. Some people have plaques for many years without any disease symptoms. This suggests that other factors, such as genetics or lifestyle, may also play a role in the development of Alzheimer’s.

There is no single cause of Alzheimer’s, but rather a combination of genetic, lifestyle, and environmental factors. Some of the most well-known risk factors for Alzheimer’s include:

  • Age: The risk of developing Alzheimer’s increases with age. About 1 in 10 people over 65 have Alzheimer’s, and the risk increases to about 1 in 3 people over the age of 85.
  • Family history: If you have a parent or sibling with Alzheimer’s, you are more likely to develop the disease.
  • Genetics: Certain genes have been linked to an increased risk of Alzheimer’s. However, having these genes does not mean that you will develop the disease.
  • Lifestyle factors: Some lifestyle factors that may increase your risk of Alzheimer’s include:
    • Head injury: People who have had a head injury are more likely to develop Alzheimer’s.
    • Depression: People with depression may be at increased risk of Alzheimer’s.
    • Lack of exercise: People who are physically inactive are more likely to develop Alzheimer’s.
    • Poor diet: People who eat a poor diet are more likely to develop Alzheimer’s.
    • Smoking: Smoking is a risk factor for Alzheimer’s.
  • Environmental factors: Some environmental factors that may increase your risk of Alzheimer’s include:
    • Exposure to heavy metals: Exposure to heavy metals such as lead and mercury may increase your risk of Alzheimer’s.
    • Air pollution: Exposure to air pollution may increase your risk of Alzheimer’s.

So, while plaque buildup is a risk factor for Alzheimer’s, it is not the only cause.

Donanemab slowed Alzheimer’s disease progression by 35% relative to placebo, but 37% of participants treated with donanemab experienced brain swelling and bleeding called ARIA. How will that risk be explained to patients and family members?

What will be the cost to Medicare and taxpayers? Does the benefit outweigh the risks? These are not easy answers but the medical community needs to address these challenges and ensure that patients understand the risks and costs.

Pharma companies see a lot of money in attacking Amyloid beta, but the risks are enormous, as well as the burden to American taxpayers.