Novel therapies for Alzheimer's disease, particularly anti-amyloid drugs like lecanemab and donanemab, have shown modest clinical benefits but also significant risks. The present paper highlights the challenges of access to diagnosis, cost-effectiveness, safety, and the need for more representation of diverse populations in clinical trials. Recommendations include careful patient selection, risk-benefit analysis, and the importance of proven amyloid pathology for treatment. Future work involves further research on anti-amyloid therapies in Brazil and the development of more effective treatments for Alzheimer's disease.
Novas terapias para a doença de Alzheimer, particularmente os anticorpos monoclonais antiamiloides como o lecanemab e o donanemab, demonstraram benefícios clínicos modestos, mas também riscos significativos. O presente artigo destaca os desafios do acesso ao diagnóstico, da relação custo-eficácia, da segurança e da necessidade de maior representação de populações diversas em ensaios clínicos. As recomendações incluem seleção cuidadosa dos pacientes, análise de risco-benefício e a importância da patologia amiloide comprovada para o tratamento. Trabalhos futuros envolvem mais pesquisas sobre terapias antiamiloides no Brasil e o desenvolvimento de tratamentos mais eficazes para a doença de Alzheimer.
Keywords:
Alzheimer Disease; Amyloid; Antibodies, Monoclonal; Therapeutics.
Grants and funding
BJAPB participated as a speaker in symposiums promoted by the laboratories Sandoz, Roche, Knight Therapeutics, Novo Nordisk, and Lilly, participated on the advisory board of Roche, and received financial support for participation in events from Novo Nordisk. OVF is a principal investigator in a clinical trial for Biogen (ENVISION). EPFR received support from Proneuro for the preparation of educational materials, from Novo Nordisk for conference attendance, and from Roche for participation in educational activities. PHFB received honoraria from Neurimmune, RMC received Alzheimer’s Association grant (AARGD-21-846545), and is funded by the National Council for Scientific and Technological Development (CNPq, Brazil) for research productivity grant. GBPF received participation as a speaker in symposium sponsored by Lilly and Roche. MLFB participates in research sponsored by Roche. NAFF received honoraria for participation on advisory boards for Roche. LPS received honoraria for participation on advisory boards for Biogen, Knight, Lilly, Novo Nordisk, and Roche, and for the development of continuing medical education material by Aché, Apsen, Biogen, Knight, Libbs, Novo Nordisk, and Roche. LCS received honoraria for participation on advisory boards for Biogen and Lilly, for the development of continuing medical education material, and participation as a speaker in a symposium sponsored by Abbott, Biogen, Knight, and Novo Nordisk; he is a principal investigator in a clinical trial for PassageBio. SMDB received honoraria for participation in the advisory board for Biogen, Novo Nordisk, Lilly, Roche, and Adium. PC participated in a clinical trial sponsored by Novo Nordisk, participated in consulting activities for Aché, Danone, Eurofarma, Knight Therapeutics, and Roche, and prepared continuing medical education materials and participation as a speaker in symposia sponsored by Aché, Danone, Grupo Fleury, Novo Nordisk, and Roche. ASN received honoraria for participation on advisory board for Roche. RN and SMDB are funded by CNPq, Brazil (research productivity grant). AMC, WVB, MNMS, ACSAF, MTB, JS, and EE have no conflicts of interest to declare.