Breakthrough Drugs Herald "New Era" in Battle Against Dementia, Experts Predict

Pills that prevent Alzheimer’s disease or blunt its effects are on the horizon as the fight against dementia enters a “new era,” experts have said.

Jeff Cummings, a professor of brain science and health at the University of Nevada, said scientific advances were on the cusp of producing medicines that could be used even in the most remote and under-resourced parts of the world, thereby “democratizing” care.

An estimated 50 million people live with dementia globally, more than two-thirds of them in low- and middle-income countries.

The first drugs that can change the course of Alzheimer’s disease entered the market in 2024. In many Western countries, including the UK and the US, Eisai and Biogen’s lecanemab and Eli Lilly’s donanemab were approved by medicine watchdogs.

“I’m just so excited about this,” said Cummings. “We are truly in a new era. We have opened the door to understanding and manipulating the biology of Alzheimer’s disease for the benefit of our patients.”

Cummings conceded that high prices, complicated administration techniques, and requirements for advanced technology to monitor patients meant those newly approved drugs were “not going to be made widely available in the world.”

Neither is available on the NHS in the UK because of the high cost – about £20,000 to £25,000 a year for each patient. They require additional tests and scans that would probably double that figure.

However, Cummings said they offered evidence of how to target dementia, and “this learning is going to open the door to new therapies of many types, and those drugs can be exported around the world.” Currently, 127 drugs are in trials for Alzheimer’s disease.

Cummings, who works with several pharmaceutical companies on trials and drug development, said lecanemab and donanemab, which prompt the body to remove amyloid plaque in the brain, slow the decline by about 30%.

Before treatment, patients need a diagnosis confirmed by a hi-tech PET scan or a lumbar puncture. Follow-up monitoring requires brain scans. The equipment and expertise necessary are in short supply in many countries, and the drugs are given intravenously – a further constraint.

However, Cummings highlighted recent decisions by the US regulator, the Food and Drug Administration, allowing Alzheimer’s diagnosis based on a blood test as the enrolment criterion for dementia drug trials.

That could allow blood tests that look for “biomarkers” of dementia to be used in clinics to diagnose patients instead of expensive scans.

Meanwhile, trial results suggest the new drugs could instead be delivered by injection beneath the skin, opening the door for at-home administration by a nurse or caregiver.

“Ultimately, we want oral medications, some pills that can be taken once a day,” said Cummings, speaking alongside Paola Barbarino, chief executive of Alzheimer’s Disease International (ADI), after the organization’s end-of-year forecast event.

Tablet forms of semaglutide – better known as Ozempic, an injectable drug for diabetes that is used off-label for weight loss – are already in trials for Alzheimer’s, and results are expected in late 2025. In chairing those trials, Cummings said there was plausible reason to think the drug would be adequate by reducing inflammation, which was “a fundamental part of the illness.”

He called for more involvement of low—and middle-income countries in clinical trials to boost knowledge of how the drugs work among different populations and to increase scientific capacity and understanding of dementia in those places.

Could there be a cure for Alzheimer’s? That was “difficult”, Cummings said. But, he added.

“We know enough about manipulating biology and how it starts that we can, I think, within my lifetime – maybe a little bit longer, because I’m not young – we can control the processes that start the illness, and therefore, it simply wouldn’t develop in the brain.”

Experts believe 40% of Alzheimer’s cases could already be prevented by targeting key risk factors, such as smoking, drinking alcohol, and air pollution.

Prices would need to come down for low- and middle-income countries to “even think” of affording drugs that can change the course of Alzheimer’s disease, Barbarino said.

Attitudes would also need to change, she said, adding: “When I speak to health ministries in some poorer countries, they tell me they don’t have dementia in their country, which, of course, is not true.”