New Alzheimer’s drug in demand but who should take it?

A new drug to treat Alzheimer’s disease has given new hope to those affected by the disease and their loved ones.

Donanemab, developed by Eli Lilly and sold under the brand name Kinsula, was approved by the Food and Drug Administration in July to treat patients with early Alzheimer’s disease and people with mild cognitive impairment.

In the following weeks, USF Health’s Center for Memory Disorders and the Byrd Alzheimer’s Center and Research Center received more than 50 calls from patients and families hoping to receive the medication.

But the drug is not suitable for every patient with Alzheimer’s disease or ‘dementia’. The potential side effects and risks, weighed against the small benefits for those with Alzheimer’s disease, mean that experts have to say “no” to many patients, said Ram Bishnoi, assistant professor of University of South Florida working in the Department of Psychiatry. Behavioral Health at the Byrd Alzheimer’s Center.

“There are too many calls,” he said. “We are still overwhelmed with patients.”

Here is a list of what Alzheimer’s patients need to know about the new drug:

Why is Donanemab so popular?

An estimated 6.7 million Americans are living with Alzheimer’s disease, the fifth leading cause of death among people age 65 and older by 2021, according to the Alzheimer’s Association. About 580,000 people in Florida have been diagnosed with the disease, which costs the state Medicaid program $3.4 billion a year.

Alzheimer’s disease is caused by the accumulation of amyloid proteins that form plaques in the brain. It affects functions such as memory and muscle coordination. Although not a cure, Donanemab can significantly slow the progression of the disease, clinical trials have shown. It does not convert memory loss into loss of cognitive function.

Who should take the medicine?

According to the FDA, the drug is approved people with early signs of Alzheimer’s disease, including mild cognitive impairment and those with mild dementia of Alzheimer’s disease who have confirmed accumulation of amyloid plaques. The drug does not work in people with moderate or severe Alzheimer’s. It should also not be for those with dementia for other reasons.

How does the drug work?

Donanemab is an anti-amyloid monoclonal antibody given intravenously once a month. Antibodies bind to the amyloid proteins and remove them.

What are the risks?

Side effects of the medication include imaging abnormalities associated with amyloid, which usually shows up as swelling and small spots of bleeding in the brain. In most cases, these side effects are only detected by magnetic resonance imaging – known as MRI – and patients are unaware of them. There is also a risk of infusion-related reactions such as flu-like symptoms, which can include nausea, vomiting and changes in blood pressure.

Are there other factors that increase the risk?

Yes. People on blood thinners or anti-coagulants are at greater risk of side effects, which can be fatal. Doctors should use “extreme caution” when prescribing the drug in those cases, Bishnoi said.

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Also, people who cannot have MRIs, such as those with metal implants, should not be given medication as MRIs are used to monitor adverse reactions in the brain, Bishnoi said.