The approval of new antibody-based drugs for Alzheimer’s disease—lecanemab and donanemab—and of blood-based diagnostic tests marks the beginning of a new era in the diagnosis and treatment of this condition. However, without swift reforms in healthcare systems, public policies, and social attitudes, their full potential will not be realized, warn 40 leading Alzheimer’s experts in The Lancet Series on Alzheimer’s disease.
Alzheimer’s disease accounts for approximately 70% of all dementia cases and is one of the leading causes of disability, resulting in high social and economic costs.
In a novel comparison, the series highlights that new monoclonal antibody treatments can slow the progression of Alzheimer’s disease to a level comparable with the effectiveness of drugs used in cancer, rheumatoid arthritis, and multiple sclerosis. Nonetheless, the authors note that differences in patient age, clinical outcomes, and side effects mean these comparisons must be interpreted with caution.
| Disease | Alzheimer’s (lecanemab) | Alzheimer’s (donanemab) | Early-stage breast cancer | Lung cancer | Multiple sclerosis | Rheumatoid arthritis |
| Efficacy in delaying progression | 8% | 10% | 9% | 32% | 4% | n/a |
| Reduction in progression on disability scales | 0.19 | 0.26 | n/a | n/a | 0.20 | 0.25 |
Despite the similarity in treatment effectiveness for other diseases, the high costs of the drugs, the complex requirements of diagnostic testing, suboptimal attention to behavioral symptoms, and insufficient resources threaten to leave Alzheimer’s patients behind.
Encouragingly, improvements in Alzheimer’s disease prevention are also on the horizon, with the emergence of Brain Health Services, which identify people at high risk of developing the disease and provide them with personalized treatment programs. However, most Alzheimer’s cases occur in individuals at low or normal risk, making population-level measures that reduce risk—such as healthier urban design and restrictions on alcohol and sugary drinks—essential.
The authors call for coordinated global action to ensure that rapid scientific progress in the field of Alzheimer’s disease is matched by reforms in healthcare provision, policies, and society.
Among the series’ authors are two Spanish researchers: Dr. Juan Fortea, from the Sant Pau Research Institute (IR Sant Pau) and head of the Sant Pau Memory Unit, and Dr. Eider Arenaza-Urquijo, from ISGlobal. Both contributed to the section on diagnosis, a field currently undergoing a true revolution thanks to the arrival of blood biomarkers. These tests make it possible to detect biological changes of Alzheimer’s even before the first clinical symptoms appear, opening the door to interventions at very early stages of the disease and maximizing the impact of new treatments.
In Dr. Fortea’s words, “We are witnessing a milestone in the treatment of Alzheimer’s with the first drugs capable of modifying the course of the disease. This breakthrough makes continued progress in diagnosis even more significant and important, especially with the development of biomarkers that allow us to identify patients in the earliest stages. Only then can we ensure that new treatments are administered at the right time and have the greatest possible benefit for patients.”
The lead author of the series, Professor Giovanni Frisoni from the University of Geneva (Switzerland), states, “Blood tests, biological drugs for Alzheimer’s disease, and preventive interventions are shifting care into an entirely new and exciting landscape. However, patients’ longstanding needs will not disappear. On the contrary, more primary care physicians and dementia specialists will need to master the less flashy but steady advances made over recent decades in the care and treatment of behavioral disorders. This includes the use of sophisticated imaging and laboratory diagnostic tools, and psychosocial care. A concerted societal effort in this direction will ensure that our current and future patients fully benefit from the potential of scientific and technological advances.”
To access the articles, visit:
https://www.thelancet.com/series-do/alzheimers-disease
