Alzheimer’s Disease

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Alzheimer’s Disease

Context:

Donanemab, a new therapy for Alzheimer’s disease developed by drug maker Eli Lilly, has received unanimous support from independent scientists advising the United States Food and Drug Administration (USFDA), bringing it a step closer to clinical use. 

 

More on news:

  • The FDA advisory committee stated in a briefing document that the potential risks of donanemab,
    • when appropriately managed according to labelling instructions, are outweighed by the demonstrated benefits on clinical endpoints in individuals with Alzheimer’s disease (AD).
  • There were few reason to delay in approval,
    • Therapy was stopped in patients who achieved a specific level of amyloid beta plaque clearance.
    • Additional scrutiny followed a US congressional committee’s investigation into the approval process of aducanumab, revealing irregularities.
    • Approval was given despite clinical trial cancellation and an expert panel’s recommendation against it.

 

Donanimhaber Overview and Mechanism of Action:

  • It  is a monoclonal antibody targeting amyloid beta protein depositions in the brain, a key feature of Alzheimer’s disease.
  • Phase 3 study: Slows cognitive decline by 35.1% over 76 weeks.
  • Main adverse effects: Brain swelling (24% of participants) and brain bleeds (19.7% of participants), mostly asymptomatic.

 

  • Benefits:
    • Designed for early-stage Alzheimer’s disease patients, specifically those with mild cognitive impairment or mild dementia.
    • Shows significant and clinically meaningful slowing of disease progression.
    • Function Retention: Patients on the drug retain their cognitive and functional abilities for a longer period.

 

  • Risks:
    • Adverse Effects: Includes amyloid-related imaging abnormalities (ARIA) such as brain bleeds and seizures, Most ARIA events were non-serious.
    • ARIA events typically resolved or stabilised after discontinuation of therapy.

Alzheimer's Disease

Importance of the Breakthrough:

  • Rising global burden of Alzheimer’s, emphasising the need for such drugs, especially in developing countries.
  • Estimated 5.3 million people in India currently have dementia; projected to increase to 14 million by 2050.
  • High cost of treatment and the need to weigh benefits against financial burden, despite the innovation’s potential.

About Alzheimer’s disease:

  • It is a brain disorder that gets worse over time. 
  • It’s characterised by changes in the brain that lead to deposits of certain proteins. 
    • It causes the brain to shrink and brain cells to eventually die.
  • It is the most common cause of dementia — a gradual decline in memory, thinking, behaviour and social skills. 
    • These changes affect a person’s ability to function.
  • The causes probably include a combination of age-related changes in the brain, along with genetic, environmental, and lifestyle factors.
  • In most people with Alzheimer’s, symptoms first appear later in life.
  • Dementia: It is a syndrome that can be caused by a number of diseases which over time destroy nerve cells and damage the brain, typically leading to deterioration in cognitive function 
    • Alzheimer disease is the most common form of dementia and may contribute to 60–70% of cases.
  • Dementia ranges in severity from the mildest stage, 
    • when it is just beginning to affect a person’s functioning, 
    • to the most severe stage, when the person must depend completely on others for help with basic activities of daily living.
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