Journal Article Journal Article Ppublish 9 citations
PubMed: 39105453 DOI: 10.1002/alz.14108
Considering challenges for the new Alzheimer's drugs: Clinical, population, and health system perspectives.
Alzheimers Dement 20(9):6639-6646
Authors: Sebastian Walsh, Richard Merrick, Richard Milne, Shirley Nurock, Edo Richard, Carol Brayne
Affiliations
- Cambridge Public Health, University of Cambridge, Cambridge, UK.
- Kavli Centre for Ethics, Science, and the Public, University of Cambridge, Cambridge, UK.
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands.
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
Abstract
Recent approvals of amyloid immunotherapy drugs for early Alzheimer's disease (AD) have been highly controversial. In this piece, we consider challenges from the clinical, population health, and health systems perspectives to the role that the new AD drugs might be expected to play, now and in the future, in alleviating the morbidity caused by AD in the population. Clinically, short-term effects are small, adverse events are frequent, treatment regimens are burdensome, and, crucially, long-term effects are unknown. At a population level, there is always likely to be a trade-off between breadth of access and magnitude of benefit for any given individual. At a health system level, roll out of treatment even for only narrowly-defined patient groups will involve considerable resources to identify and treat eligible patients, with profound opportunity costs. Our considered view on current evidence is that there are challenges from each perspective to imagining a foreseeable future in which amyloid immunotherapy significantly alleviates AD morbidity at scale. HIGHLIGHTS: Recent approvals of Alzheimer's drugs have met with excitement but also controversy. Trial effects are small, adverse effects concerning, and long-term effects unknown. Results from trial cohorts may not generalize to broader, more complex patients. Significant resource requirements of eligibility assessment and drug administration. Use in "presymptomatic" populations is not supported by current evidence.
MeSH
Dementia, Epidemiology, Alzheimer Disease, Pharmaceutical Preparations, Public Health, Immunotherapy, Morbidity, Therapeutics, Amyloid
Cited by
- Mechanisms of interventions targeting modifiable factors for dementia risk reduction. Mol Neurodegener, 2025
- Considering challenges for the new Alzheimer's drugs: Clinical, population, and health system perspectives. Alzheimers Dement, 2024
- Preclinical evidence and potential mechanisms of tanshinone â…¡A on cognitive function in animal models of Alzheimer's disease: a systematic review and meta-analysis. Front Pharmacol, 2025
- Systematic review of amyloid-beta clearance proteins from the brain to the periphery: implications for Alzheimer's disease diagnosis and therapeutic targets. Neural Regen Res, 2025
- Incorporating individually defined brain health priorities in clinical trial outcomes: the electronic Person-Specific Outcome Measure approach in the United States. Alzheimers Dement (N Y), 2025
- Cost-effectiveness of diagnosing and treating patients with early Alzheimer's disease with anti-amyloid treatment in a clinical setting. J Alzheimers Dis, 2025