Breakthrough drugs herald ‘new era’ in battle against dementia, experts predict

An estimated 50m people live with dementia globally, more than two-thirds of them in poorer countries, but diagnosis and monitoring currently need costly scans.

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.

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 “democratising” care, said Jeff Cummings, professor of brain science and health at the University of Nevada.

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

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

“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," Mr Cummings said.

He conceded that high prices, complicated administration techniques, and requirements for advanced technology to monitor patients meant that those newly approved drugs were “not going to be made widely available in the world”. It could cost around €40,000 at least for each patient.

But Mr 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”. There are currently 127 drugs in trials for Alzheimer’s disease.

Lecanemab and donanemab — which prompt the body to remove amyloid plaque in the brain — slow decline by about 30%, said Mr Cummings, who works with a number of pharmaceutical companies on trials and drug development.

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

That could pave the way for those blood tests, which look for “biomarkers” of dementia, to be used for diagnosis in clinics in place of expensive scans.

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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 Mr Cummings, speaking alongside Paola Barbarino, chief executive of Alzheimer’s Disease International (ADI) after the organisation’s end-of-year forecast event.

Tablet forms of semaglutide — better known as Ozempic, an injectable drug for weight-loss — are already in trials for Alzheimer’s and results are expected in late 2025. Mr Cummings, who is chairing those trials, said there was plausible reason to think the drug would be effective 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, in order to boost knowledge of how the drugs work among different populations and to increase scientific capacity and knowledge of dementia in those places.

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

The Guardian