Alzheimer’s, how the breakthrough drug works

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The green light in the United States al first drug which slows down the course of the Alzheimer’s disease when he is still in very mild form, he has been greeted with a relief that is difficult to describe for those who, for a lifetime, have been treating people with Alzheimer’s and, for a lifetime, have known that their weapons are substantially blunt. The wait for news lasted twenty years. It is now over and, albeit with caution, it still represents a turning point because the approved drug is the first drug that acts on the course of the disease and is not limited to attacking the symptoms.

“It is a historic and epochal turning point for everyone” the reaction of Orazio Zanetti, director of the Alzheimer Unit – Center for Remembrance of the Irccs (Institute of hospitalization and scientific treatment) Fatebenefratelli of Brescia. Satisfaction. “We are happy as a scientific community and for patients – he says -. After twenty years of darkness, frustration, bitterness and failure, the US government agency has approved the use of a drug that clears the brain of the accumulation of beta-amyloid, the main protein responsible for Alzheimer’s. It is a innovative antibody which acts as a scavenger on the plaques that form in the spaces between the nerve cells of the brain. In practice, it attacks the amyloid fragments and dissolves them. Studies have shown that it improves both the cognitive course and the functional autonomy of people at the onset of the disease ».

It is not for everyone. The first drug that will help the sick, but not all. «It is used for people with very mild cognitive disorders and which represent a wake-up call towards a future marked by the disease – continues Zanetti -. Candidates must be selected very carefully and undergo a series of tests to understand if they are actually signs of Alzheimer’s ».

Early diagnosis relies on the use of biomarcatori liquorali (reliable in people aged between 55 and 70 years, then more) and of images obtained through the Pet for amyloid. “The amyloid it accumulates in the brain twenty-five years earlier of the full-blown disease – explains Zanetti -. For about twenty years the person has no symptoms. Then they begin, but for about five years they are mild and do not impair functions (e.g., talking or walking, DNR). This is the period in which it is possible to start therapy with the new drug, provided that the presence of the beta-amyloid protein has been ascertained in the patient ».

In Brescia the people with dementia are about 14 thousand, eight thousand of them with Alzheimer’s disease. Of these, the current candidates for therapy, when it will be approved also in Europe and Italy (estimated by the end of the year), are about 1,500 of the 2,800 who have developed the mild form of the disease and are those in which beta-amyloid is present.

«The new drug will have a huge impact on diagnostic services which will understandably be stormed by people who want to be diagnosed. Beyond the technologies, the management of biomarkers in Brescia is carried out at the Irccs Fatebenefratelli and at the Civil Neurology directed by Professor Padovani where clinical studies on Alzheimer’s have been carried out for years – concludes Dr. Zanetti -. Today we see patients in the clinic on average every six months, also because when the disease becomes full-blown the damage is done and it is impossible to slow down its course.

The new monoclonal antibody therapy consists of one monthly intravenous which must be done in specialized centers. Then, every two months you will have to do an MRI to check for any side effects. It will be a tsunami, but it will make it possible to diagnose the disease in a very mild phase and affect the course ».

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