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Medical research has reached new milestones in one of the most complex diseases scientists have ever faced: Alzheimer's. It is one of the cruellest diseases, because it impacts both the patient, who loses their identity in the process, and their family. A spark of hope has appeared now with the approval of two new drugs- lecanemab and donanemab. Once they arrive in Spain, they could benefit around 10,000 people in Malaga province.
However, 10,000 is just a rough estimate of the number of people with the disease. Alzheimer's is one of the most under-diagnosed diseases, given the similarities it shares with dementia, especially in the early stages.
José María García-Alberca, scientific director of the Andalusian institute of neuroscience (IANEC) said: "These two drugs are monoclonal antibodies which, administered intravenously, reach the brain and aim to eliminate excessive abnormal deposits of the beta-amyloid protein."
In Alzheimer's disease, the destruction of neurons is directly proportional to the deposit in the brain of two "abnormal proteins, beta-amyloid and tau". "The brain naturally generates them, but the disease produces them excessively. They have an abnormal structure, which infiltrates and kills neurons. The initial deposits of beta-amyloid and tau protein form in the brain at least 20 to 25 years before even the subtlest symptoms appear. So, if a person begins to show symptoms at age 73, the neuropathological damage likely began around the age of 50."
Research, as García-Alberca explained, has made it possible to detect the presence of these components in the silent phase of the pathology with "special resonance scans". After years of searching for effective drugs without side effects, these new drugs successfully target the accumulation of beta-amyloid in the brain.
Both medicines have been approved in the US. Lecanemab has received the green light by the European Medicines Agency (EMA), but donanemab has not. When the protein is removed, there is less neuronal damage, which helps both medications to slow the rate of cognitive decline by up to 27% with lecanemab and nearly 40% with donanemab. This means that "the onset of the most advanced stages of the disease can be shifted back by several years. We are talking about approximately three to five years of life", said García-Alberca.
Head of the neurological unit at Malaga's Clínico Universitario Virgen de la Victoria - Carlos Cruz - also commented on the medical milestone, stating the lecanemad "has a direct impact on the molecular pathology of the disease". He added that the medicine will "be able to prolong" life for "three to five years", additionally improving the quality of life.
The drawback is that lecanemab can "only be used in the early stages of the disease". It is administered intravenously, twice a month, in thirty to forty-five minute sessions. Donanemab has an identical use and action, but is administered once a month.
Once the EMA has given its approval to lecanemab, the 27 EU states will have to decide how to fund it and how to introduce it in their respective national health systems. The cost is high: around 30,000 euros per year. In other words, there are still months to go before it is administered in the Andalusian health service (SAS). However, donanemad was rejected by the EMA at the end of March, despite having been approved in the US and the UK. This is not a concern for Dr García-Alberca, as the same happened with lecanemab at first, but the pressure from the international scientific community was so strong that it was finally given the green light.
The medical expert said that it is normal for things to go slowly, but he urged authorities to treat the issue with priority.
On 22, 23 and 24 May, the Andalusian institute of neuroscience (IANEC) is holding the 8th Malaga Alzheimer's Conference, with the aim to "establish a space for updating and debate, dedicated to knowledge of the disease and other dementias". As Dr García-Alberca said, the conference brings "together the most important clinicians and researchers" in Spain, who discuss a variety of topics related to such diseases. "It is a meeting attended by professionals, neurologists, geriatricians, psychiatrists, family doctors, psychologists and neuropsychologists, among others (...)."
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