Chase Bauman, B.S., B.A., Steven Lippmann, M.D.

Is Alzheimer’s Disease bad? Yes, … it robs people of cognitive abilities, global function, gait, and can induce depressive and/or paranoid features.

Do we want to cure? Yes, … but we want one that is effective, safe, available, affordable, and approved by regulatory authorities after a thorough scientific review.

All previous anti-Alzheimer pharmaceuticals have been a disappointment. That even includes the more recent ones like cholinesterase inhibitor drugs and memantine; there were others before those that were even less efficacious.

In recent years, there has been new interest in this field, hoping to mitigate Alzheimer’s Disease clinically.  There have been three publicized medicines that hopefully might reduce amyloid deposition in the central nervous system and by plaque removal from the brain return intellectual capacity or at least halt progression of the clinical pathology. Questions about whether this theoretical approach has scientific merit are still open.

Aducanumab was the first one of these IgG1 monoclonal antibody medications. It was approved in 2020, unfortunately under political pressure and proved to be a suboptimal medicine. It was not too effective, sometimes induced adverse brain-related consequences, and was exorbitantly expensive. Next came lecanemab in 2023; it also was no panacea.

Donanemab is the next such agent under consideration. Hopefully, it may be of more benefit to people with Alzheimer’s Disease. Its safety profile and clinical efficacy are still under investigation; much of the research is not yet completed or published. Particular concern focuses on whether it pathologically induces amyloid related imaging abnormalities (ARIA). Availability and cost are still unknown.

We have so far witnessed some dashed hopes by everyone. The previous pharmaceutical releases have tarnished the reputation of our profession by prematurely releasing pharmaceuticals before a full understanding is met. This time, we hope for prudence and patience; we should neither be rushed before studies are completed nor apply pressure for quick pharmaceutical approval. A thorough understanding about safety, efficacy, cost, and comorbidities needs full consideration.

Chase Bauman, B.S., B.A. is a third-year medical student, University of Louisville School of Medicine. Steven Lippmann, M.D. is Emeritus Professor, University of Louisville School of Medicine.