30/10/2023
”Delaying the onset of symptoms is essential—not just for patients, who can remain independent for longer, but for their caregivers as well. Lilly’s data showed that most patients in the study who were taking donanemab were able to remain at the same level of dependency at which they started the trial—for most that meant they needed some reminders about daily activities, such as taking their medicine or putting out the trash or other housekeeping tasks. But they didn’t progress quickly into more dependent stages in which they would need help getting dressed, remembering to eat, and executing other critical skills. In fact, about a quarter of the people taking the drug did not move on to becoming more dependent, compared to 50% of those taking placebo during the 18 month study.
Both Eisai’s and Lilly’s data confirm that starting treatment earlier gives the medications more opportunity to clear amyloid build up and prevent damage to brain neurons. That means it might even be possible to not only delay some of the more advanced symptoms of Alzheimer’s related to memory and cognition, but to also prevent them. Dr. John Sims, senior medical director at Lilly, says that the company anticipates that donanemab will not be a life-long prescription—but that patients could use it to either remove or reach an acceptable level of amyloid in the brain, which can then be monitored as they come off the drug for periods of time. “The hypothesis we are working on is that it’s much better to monitor the disease because it is a really slow process overall, and maybe some people may never need another treatment,” he says. If these results are supported by continued follow up, that would mean focusing even more on how best to diagnose patients at the earliest stages of disease, before memory or other cognitive symptoms appear. “The data show that the most optimal benefit occurs if people are treated as early as possible,” says Irizarry.
Experts in the field are already working on honing the criteria for diagnosing Alzheimer’s, and developing guidelines for even non-dementia experts such as primary care physicians to make it easier to distinguish when people have the condition, and which patients would benefit from treatment—as early as possible.”
New data from Eli Lilly and Eisai show that their Alzheimer's drugs are more effective when started earlier.