Wednesday, June 12, 2024 4:20:24 AM
Alberto Espay
Professor of Neurology, Advocate of precision me...
11h • Edited
Open Letter To My Dear Alzheimer's Patients
Like the FDA-approved lecanemab (Leqembi), the soon-to-be-approved donanemab will not improve you. You might worsen slower than if you were not on this infusion, but by so little, you won't be able to notice it. On the other hand, you have a 1-in-3 chance of having side effects, including a 1-in-4 chance of getting brain swelling, brain bleeding, or both (we doctors sanitized these under the acronym
"ARIA," for "amyloid-related imaging abnormalities").
Also, your brain will shrink faster. A smaller brain is of great concern. There has been little transparency about what this means in the long term, but can't be good.
The attached figures give you the full perspective: the risks are high, whereas any benefits are elusive or minuscule.
You may have heard these infusions are "better than nothing" and a "first step." Sometimes, doing nothing is best. Improving nutrition and exercising are more desirable to satisfy "do something" urges. Even the old and modest donepezil (Aricept) is twice as effective as lecanemab.
Lecanemab, donanemab, and other treatments developed over the past two decades aim to remove amyloid from the brain. Amyloid is the brain's normal response to various things we get exposed to as we age, not the cause of Alzheimer's disease. Most people with amyloid in their brains do not have Alzheimer's. Removing amyloid creates the illusion of progress but does not address the underlying causes or improve memory.
One last thing. Although your health should always come before any financial considerations, lecanemab infusions are highly profitable for hospitals and doctors like me. They can also drain a family's savings and strain Medicare. We could break the bank if a treatment makes a real difference. This is not worth it.
With love, Alberto Espay, MD
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