Study breaks down Alzheimer’s treatment effects in clear terms

In the past two years, the Food and Drug Administration has approved two new Alzheimer’s therapies, based on data from clinical studies that show that both medicines delayed the progression of the disease. But while the approvals of Lecanemab and Donanemab, both antibody therapies that erase plaque-causing amyloid proteins from the brain, with enthusiasm greeted by some researchers from Alzheimer’s, the reaction of patients were filled in. According to doctors who take care of people with Alzheimer’s, many patients found it difficult to understand what the clinical tests results – presented as “percentage of decrease in the speed of cognitive decline” – intended for their own lives.

Researchers at the Washington University School of Medicine in St. Louis have devised a way to communicate the effects of taking the new Alzheimer’s medication in language that is accessible and comprehensible for patients and their families. With the help of data on the natural history of the disease and the extent of the effects of drugs such as measured in clinical studies, the researchers calculated how many months of independent life a patient from Alzheimer’s could expect by undergoing treatment. The benefits were dependent on the drug and the severity of the patient’s symptoms when the treatment began. As a representative example, a typical patient who started with very mild symptoms with very mild symptoms can expect that it would live independently for 10 months if they were treated with Lecanemab, or eight months with Donanemab.

The study, published on 13 February in Alzheimer and Dementia: Translational research and clinical interventionsOffers crucial information that can help patients and caregivers to weigh the benefits against the costs and risks of treatment.

“What we tried to do was to find out how people give a bit of information that would be useful for them and help them make decisions about their care,” said senior author Sarah Hartz, MD, PhD, a professor in psychiatry At Washu medicine. “What people want to know is how long they can live independently, not something abstract such as the percentage of change in deterioration.”

The patients and their families of Alzheimer’s are confronted with the difficult question whether they should undergo treatment that will not improve them. It will not even stop them to get worse. In the best case, the treatment with Lecanemab or Donanemab can slow down the inevitable cognitive decline that characterizes Alzheimer’s. Add the facts that the treatment is expensive, requires biweekly or monthly infusions and bears risks such as brain blood and brain swelling that are usually mild and can go away by themselves, but can be life threatening in rare cases.

But only because the benefits are limited does not mean that they are not valuable for patients and their families.

My patients want to know: ‘How long can I drive? How long can I take care of my own personal hygiene? How much time would this treatment give me?. The question of whether or not these drugs would be useful for a certain person is complicated and has to do with not only medical factors, but also the priorities, preferences and risk tolerance of the patient. “

Suzanne Schindler, MD, PhD, co-author, university teacher Neurology

Suzanne Schindler is a doctor with Washu Medicine who treats people with Alzheimer’s disease

Independent living with Alzheimer’s disease

There are two critical bending points on the continuum between independence and dependence. The first is the point at which a person can no longer live independently because of a reduced capacity to manage daily tasks, such as preparing meals, driving, paying bills and remembering agreements. The second point comes when a person can no longer take care of his or her own body and needs help with bathing, dressing and toilets.

To calculate the effects of the treatment, Hartz and her colleagues estimate for the first time when people could expect to lose each of the two types of independence if they remain untreated. They analyzed the experiences of 282 people who participated in research studies in Charles F. van Washu Medicine and Joanne Knight Alzheimer Disease Research Center. All participants met the criteria for treatment with the two new medicines, but had not received them before. The researchers also calculated how quickly the symptoms progressed without treatment.

With the help of this data on independence and progression, in combination with the reported effects of the two medicines, the researchers calculated the amount of time of a person in every phase of the disease could be expected to live independently of themselves or take care of themselves Without treatment, and how this progression would compare with those who have received treatment.

A typical person with very mild symptoms can expect that it would live independently for 29 months without treatment, 39 months with Lecanemab and 37 months at Donanemab.

Most people with mild symptoms – unlike very mild symptoms – were not able to live independently at the start, so for them the more relevant measure was how long they could take longer for themselves. The researchers calculated that a typical person at this stage of the disease could expect to manage self -care independently for another 26 months if it is treated with Lecanemab, 19 months with Donanemab.

This way to understand the effects of the medicines can help patients and their families make decisions about their care, the authors said.

“The purpose of this study is not to argue for or against these medicines,” said Hartz. “The purpose of the paper is to place the impact of these drugs in context in ways that people can help to make the decisions that are best for themselves and their family members.”

Hartz SM, Schindler SE, Streitz ML, Moulder KL, Mozersky J, Wang G, Xiong C, Morris JC. Assessment of the clinical significance of delaying CDR-SB progression with disease-modifying therapies for Alzheimer’s disease. Alzheimer & Dementia: Translational Research & Clinical Interventions. February 13, 2025. DOI: 10,1002/TRC2.70033

This study is supported by the National Institutes of Health (NIH), Grant Numbers P30 AG066444, P01 AG003991, P01 AG026276, R01 AG065234, R01 AA029308, R01 AG0141. The content is exclusively the responsibility of the authors and does not necessarily represent the official views of the NIH.