It is difficult to put into words the sadness you feel when you see a family member or close friend gradually forget everything and become unable to do even daily tasks on their own. Alzheimer's disease is such a heartbreaking condition. Until now, there have only been medications that control the symptoms, but now the world is talking about a new treatment that directly targets the cause of this disease. Today we are talking about this new hope, which is Anti-Amyloid therapy.
Simply put, what is this Anti-Amyloid treatment?
In the brain of someone with Alzheimer's disease, a type of protein called `beta-amyloid` accumulates unnecessarily. Think of it like a current passing through an electrical wire, which is how information travels between neurons in our brain. That `beta-amyloid` protein accumulates and forms rust-like `plaques` between these nerve cells. This then disrupts the flow of information. This is the main reason for memory loss and inability to think clearly.
This new class of drugs, called anti-amyloid, works by removing the accumulated `beta-amyloid` plaques from the brain. That means it attacks the underlying cause of the disease rather than just suppressing the symptoms. The hope is that by removing these plaques, brain cells will be able to function more healthily for longer.
These actually belong to a category of treatments called `immunotherapy`. To be precise, these drugs are given as a type of antibody (monoclonal antibody) specially made in a laboratory. When these antibodies enter our bodies, they find those harmful `beta-amyloid` proteins, attach to them, and destroy them.
The two main anti-amyloid drugs currently approved are `donanemab (Kisunla)` and `lecanemab-irmb (Leqembi)`. There is also a drug called `aducanumab (Aduhelm),` but it has now been withdrawn from the market by the company that manufactured it.
How do I get this treatment? Are there any side effects?
This medicine is given through a saline solution (IV infusion) into a vein. This takes about an hour. `Leqembi` is usually given every two weeks, and `Kisunla` is usually given every four weeks. You start with a small dose and gradually increase it to the dose prescribed by your doctor.
But you need to be aware of the most serious risk that comes with this treatment. It's called `ARIA (Amyloid-Related Imaging Abnormalities)`.
Simply put, this can cause some swelling in the brain or tiny spots of bleeding inside the brain. Although this often resolves on its own, it is important to keep an eye on this. That is why you should have regular MRI scans of the brain throughout the course of this treatment.
| Type of side effect | Description |
|---|---|
| ARIA (major risk) | Swelling or small bleeding in the brain. This can cause headaches, dizziness, nausea, confusion, and vision problems. |
| Other side effects | - Allergic reactions - Falls - Diarrhea |
| Special attention | Scientists suspect that this treatment may increase the risk of brain bleeding if given to someone taking blood thinners. You should definitely talk to your doctor about this. |
How effective is this medicine really?
Here's the tricky part. Studies have shown that these drugs can remove `beta-amyloid` plaques in the brain. That's a good thing.
However, there are still differences of opinion about how much the patient's memory and ability to perform daily tasks will actually improve after removing those plaques. Some studies have shown that these can slightly slow down the progression of the disease. That does not mean that the disease is completely cured, but that it slows down the disease from getting worse.
Scientists believe that the greatest results can be expected if this treatment is started in the early stages of the disease , before significant damage has occurred to the brain.
Who can receive this treatment?
This is not a treatment that can be given to every Alzheimer's patient. Currently, these are only recommended for a very limited number of people.
- For people in the early stages of the disease: That is, those with early onset Alzheimer's disease or those with a condition called 'mild cognitive impairment'. It is not yet known whether this will be beneficial for people with more advanced disease.
- For those with confirmed amyloid plaques: Before your doctor prescribes this medication, they will need to confirm whether these plaques are actually present in the brain. This may involve a PET scan or spinal tap.
Who cannot receive this treatment?
This medication has not been studied in many clinical trials, so it may be risky to give this treatment to people with the following health problems:
- People taking medications that prevent blood clotting (except aspirin).
- Those who have previously suffered from heart attacks or strokes.
- People with bleeding disorders.
- People with kidney or liver disease.
Another thing is, these treatments are very expensive . In a country like Sri Lanka, it can be difficult for many people to obtain these. These are not even that common at the moment.
Take-Home Message
- Anti-amyloid is a new type of medication that removes `beta-amyloid' plaques that accumulate in the brain and can cause Alzheimer's disease.
- This aims to treat the underlying cause of the disease rather than the symptoms.
- This can only be given to patients who are in the early stages of the disease and who have been confirmed to have plaques in the brain.
- Due to the risk of brain swelling or bleeding called ARIA, regular monitoring with MRI scans is essential during treatment.
- Understand that this treatment is still in the research stage, very expensive, and available only to a limited number of people.
- If a loved one has symptoms of Alzheimer's, the best thing to do is to talk to your doctor about more information and the treatment options that are right for you.
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