Alzheimer’s disease entering ‘a new era’ for treatment

Irish Neurological Association, Annual Meeting, Kilkenny Ormonde Hotel, 2-3 May 2024

The treatment of Alzheimer’s disease is entering a new era with the recent emergence of a new class of potentially ‘game-changing’ treatments, the Irish Neurological Association 2024 Annual Meeting heard.

Prof Tim Lynch, Consultant Neurologist at the Mater Misericordiae University Hospital and Beaumont Hospital, both in Dublin, chaired the update on Alzheimer’s disease session at the meeting. He noted the recent breakthroughs in new treatments for Alzheimer’s, following the expansion of research in recent years and the realisation that “amyloid isn’t the only solution and there are other proteins” involved in the disease.

In July 2023, the US Food and Drug Administration fully approved lecanemab for the treatment of Alzheimer’s disease. Two years earlier, aducanumab was also approved. These drugs are the first two amyloid beta-directed monoclonal antibodies that have been shown to moderately slow cognitive and functional decline in early-stage Alzheimer’s disease. However, there are still concerns about significant side-effects and the overall clinical benefits of these drugs. More drugs in this class are in development, however, and it is hoped the next generation will be more effective and tolerable, similar to the evolution of treatment for multiple sclerosis, Prof Lynch told Medical Independent.

“They [the two currently licensed agents] don’t stop it and they don’t work for everyone. But, on the other hand, it is an important breakthrough that we now have something you can take specifically for this disease and we never had that before.”

Prof Lynch said there are also promising developments emerging for potential new treatments of other neurodegenerative diseases, such as Parkinson’s and motor neuron disease.

He also stressed the importance of promoting good brain health and healthy lifestyles in an effort to reduce the risk of developing Alzheimer’s in the first place, noting the increase in the older population. “Even if you can delay the onset of Alzheimer’s by say five years that generates many benefits and savings.” Prof Lynch said the importance of brain health should be taught in schools and this is an issue he has advocated for to both the Departments of Education and Health.

During the meeting, Prof Lynch raised concern about the impact of Sláintecare on medical academia, teaching, and research in Ireland, saying the planned structures did not support innovation and optimal learning. He feared this would lead to poorer care for patients.

Prof Lynch also said that he believed the dismantling of the HSE Hospital Group structures to change to the new regional model was “an error” as they were “slowly but surely” beginning to show results. “One of our problems in Ireland is we change health policy every five-to-seven years. It’s like having vertigo…. We never give anything a chance to bed in correctly.”

Meanwhile, also speaking at the meeting, Dr John McConville, Consultant Neurologist, Ulster University Belfast, said that the CD20-specific antibody treatment rituximab should be used earlier in the disease stage in neuromuscular conditions, particularly myasthenia gravis, and not just in the later or refractory disease stages.