A promising drug for Alzheimer’s

Official figures put the number of people suffering from Alzheimer’s disease at 11 million worldwide. About 5 percent of people reaching 65 are affected, with the odds increasing to 15-25 percent among those 85 years old or older. But though it is a disease afflicting mainly seniors, cases of people in their 40s suffering from early onset of the disease have also emerged.

While there are no accurate figures for the Philippines, a study says the Philippines is one of the countries projected to “experience the consequences of rising dementia (of which Alzheimer’s is the worst manifestation) cases.”

In 2018, a team found a 10.6 percent prevalence of dementia among almost 1,400 persons aged 60 years and older, randomly selected from the Marikina City senior registry. The same team found that 85.5 percent of them had Alzheimer’s.

Alzheimer’s disease is cause for concern because, as the Department of Health itself stated, “late stage of (the) disease requires total dependence and inactivity representing an enormous burden on family and health care delivery.” This is so because, in this country, as a survey by the Philippine Statistics Authority (PSA) found in 2015, almost all (99.8 percent of 7.55 million) seniors live in their own households; with only a minuscule 14,500 seniors residing in nursing facilities. This means coping with the consequences of dementia lies squarely in the hands of one’s family and the immediate community.

The World Health Organization (WHO) said “dementia is one of the major causes of disability and dependency among older people globally. [It] has a physical, psychological, social, and economic impact, not only on people with dementia, but also on their carers, families, and society at large.”

While there is no definitive “cure” for now for Alzheimer’s, a bit of good news recently emerged after the United States Food and Drug Administration approved last week a new Alzheimer’s drug that, according to a news report, “may modestly slow the pace of cognitive decline early in the disease, but also carries risks of swelling and bleeding in the brain.”

The drug is known as lecanemab, to be marketed as Leqembi. Right now, it is likely “to generate considerable interest from patients and physicians,” since it is, says the New York Times, “more promising than the scant number of other treatments available.” Still, the FDA recommended that it be used only on patients exhibiting the early stages of the disease.

Even scientists from Eisai, a Japanese pharmaceutical company that led the development and testing of the drug, which is partnering with American company Biogen for its commercialization and marketing, have concluded that “longer trials are warranted to determine the efficacy and safety of lecanemab in early Alzheimer’s disease.”

For now, the new drug seems out of reach to the average Filipino patient. Eisai said the list price for Leqembi would be about $26,500 (almost P1.5 million) per year.

In the meantime, what can be done for those suffering from dementia, and for their caregivers and families?

Among the “principal goals” for dementia care outlined by the WHO are: facilitating early diagnosis in order to promote early and optimal management; optimizing physical health, cognition, activity, and well-being; identifying and treating accompanying physical illness; detecting and treating challenging behavioral and psychological symptoms; and providing information and long-term support to caregivers.

But first, a broad, comprehensive survey of the true extent of dementia and Alzheimer’s among Filipinos is needed, followed by, ideally, subsidized treatment options and perhaps approval of Leqembi to be marketed at a negotiated price, as has been done for other drugs, once safety issues have been satisfactorily addressed.

Health authorities say that dementia is the loss of intellectual and social abilities severe enough to interfere with daily functioning. Alzheimer’s, the most common consequence of dementia, is caused by the degeneration of healthy brain tissue, “causing a steady decline in memory and mental abilities. Increasing and persistent forgetfulness, of recent events or simple directions, what begins as mild forgetfulness persists and worsens. People with Alzheimer’s routinely misplace things, often putting them in illogical locations. They frequently forget names, and eventually, they may forget the names of family members and everyday objects.”

Indeed, it is this “disappearance” of the person into the worst manifestations of Alzheimer’s that is most heartbreaking for family, friends, and caregivers. Something needs to be done to address its worst effects, since it is a finish line that many of us may need to cross eventually.