Inequity needs addressing as new Alzheimer's treatments set for approval

A new wave of drug treatments for Alzheimer’s dementia, the first in 30 years, is about to arrive in Australia but Dr Tom Russ worries that “huge health inequalities” could result from their very high costs. Find out what more about what Tom will share on the issue when he speaks at #IDC2024...

Dr Tom Russ, Director of Alzheimer Scotland Research Centre, will set the tone for #IDC2024 on Day 1 by providing us with an insight into the latest treatment advances in the dementia arena.

Tom, a world-leading clinician and researcher in the field, works from Edinburgh in the UK where, as in Australia, people living with mild or early-stage dementia, their families and clinicians wait anxiously for licensing decisions on the monoclonal antibody drugs Lecanemab and Donanemab.

Both have been granted US Food and Drug Administration approval, and Tom expects their UK licensing is imminent, while in Australia Lecanemab awaits first a Therapeutic Goods Administration approval and then Pharmaceutical Benefits Scheme listing, with Donanemab close behind.

These are not cures; but whereas available medicines alleviate some dementia symptoms, the new immunotherapeutic drugs are the first disease-modifying treatments – they potentially delay and slow the course of the condition.

“I hope this is the start of a very positive period in the treatment of Alzheimer’s dementia,” says Tom.

“And I don’t want to be dismissive of the hope that these developments bring.

“But, equally, it’s just not fair if a tiny fraction of people living with dementia get some shiny new treatment and everybody else gets nothing.

It’s just not fair if a tiny fraction of people living with dementia get some shiny new treatment and everybody else gets nothing.

“Rather, what I think would be fairer is that everybody gets an enhanced degree of support after a dementia diagnosis.”

The new drugs are highly expensive; a course of Lecanemab, marketed by Eisai Co. as Leqembi, costs $40,000 per annum and the recommended treatment period is 18 months.

In addition, both drugs need to be administered by infusions in hospital settings – fortnightly with Lecanemab and monthly for Eli Lilley and Co’s Donanemab (sold as Kisunla) – and require costly clinical monitoring, including brain scans, throughout.

“We can’t give that treatment to everybody because that amount of money doesn’t exist in Britain’s health system or in Australia’s,” says Tom

Further, he says, only 5-15% of people living with dementia will be suitable for the new treatments.

Alzheimer’s accounts for about 70% of dementia cases, but the new drugs are less effective in later-stage cases, or when people also have other health conditions, and there are side-effects and allergic reactions.

In trials, the monoclonal antibodies caused marked plaque reduction in people with mild cognitive impairment and early dementia due Alzheimer disease and slowed progression of the condition.

“Scientifically, it’s a very exciting step but the clearing and breaking up of amyloid plaques is not associated with major changes in the person,” he says.

“They weren't transformative.

While we are developing the disease-modifying treatments of the near future, we need much more assistance for existing dementia services...

“While we are developing the disease-modifying treatments of the near future, we need much more assistance for existing dementia services to diagnose, treat and support people who are currently presenting.”

In addition to his keynote address, Tom will also speak on a panel on Day 2 about the challenges of keeping people living with complex dementia in their own homes and communities, and future support services needed to allow more of them to do that.