Medications to Slow Disease Progression

Editor's note: Aduhelm™ (aducanumab) was discontinued on November 1, 2024. It was not discontinued due to safety or efficacy reasons. People taking Aduhelm should talk to their doctor as soon as possible to determine the next steps for their treatment plan. Learn more about aducanumab updates.¹

There is not yet a cure for Alzheimer’s disease. But the US Food and Drug Administration (FDA) has approved 3 medicines that address one of the identified underlying causes. These drugs slow disease progression for people with early Alzheimer’s disease. They work by removing a protein called amyloid from the brain.^2-4

These drugs are not meant for everyone with Alzheimer’s disease. They should be used only by people who have all of the following:^2,4

• Early disease
• Mild symptoms
• Confirmed amyloid levels in the brain

Talk to your doctor about the right treatment options for you.

Why is slowing disease progression important?

Slowing Alzheimer’s progression can change the course of the disease for people in the early stages. Medicines that slow disease progression reduce the speed of cognitive decline. This includes slowing decline in:^2,3

• Memory
• Orientation
• Judgment and problem-solving
• Personal care
• Home life and hobbies
• Independent daily functioning

Receiving treatment for 18 months can delay symptom worsening by about 6 months. This can give you more time to live independently. It can also let you carry out daily tasks for longer. However, these treatments will not restore or reverse memory loss. They will not stop disease progression or cure Alzheimer’s disease.^2-4

How do medicines that slow disease progression work?

Current medicines that slow disease progression are anti-amyloid treatments. They work by targeting a protein called beta-amyloid or amyloid beta. Beta-amyloid is a protein that forms small clusters in the brain.^2,4,5

These clusters form chains and sheets that clump together into plaques. Plaques of amyloid beta disrupt communication between brain cells. This eventually kills brain cells. Beta-amyloid plaques may be the main cause of Alzheimer’s disease.⁶

Anti-amyloid treatments work in different ways to remove amyloid from the brain. They are all antibodies (proteins) designed in the lab to attach to amyloid beta. They each bind to different parts of amyloid beta proteins. They also target amyloid beta at different stages of clumping.^2,5,7

Examples

Three drugs that target beta-amyloid and slow disease progression are approved to treat Alzheimer’s disease:^2,4,8-10

• Leqembi® (lecanemab-irmb)
• Kisunla® (donanemab-azbt)

These drugs slow the rate of disease progression by 20 to 30 percent after 18 months of treatment. They:^2,4,5,11

• Are given as an infusion into a vein
• Reduce beta-amyloid plaques
• Slow cognitive and functional decline

The FDA approved these drugs to treat people with early Alzheimer’s disease who have high levels of amyloid beta. This includes people with mild cognitive impairment or mild dementia. Before treatment, your doctor will perform tests to measure your beta-amyloid levels. They will do magnetic resonance imaging (MRI) before and during treatment.^2,4,5,11

Several other anti-amyloid treatments have been developed. Some of them have failed to slow disease progression, but others are still in clinical trials to evaluate their effectiveness and safety.^3,5

What are the possible side effects?

Side effects can vary depending on the specific drug you are taking. Common side effects of anti-amyloid treatments include:^2-4

• Amyloid-related imaging abnormalities (ARIA)
• Infusion-related reactions
• Headaches
• Falls

ARIA is common and usually does not cause symptoms. But it can be serious. It is usually a temporary swelling in certain areas of the brain. Symptoms of ARIA include headache, dizziness, and nausea. Some people have a genetic risk factor for ARIA. Talk to your doctor about your risk.^2-4

These are not all the possible side effects of medicines that slow the progression of Alzheimer’s disease. Other medical conditions, such as significant prior brain bleeding or recent strokes, or certain medicines like anticoagulants (blood thinners) may increase the risk of side effects. This may prevent someone from being prescribed anti-amyloid therapies. Talk to your doctor about your medical history, current medicines, and what to expect when taking these drugs. Call your doctor if you have any changes that concern you.

Other things to know

Drugs that slow disease progression are expensive. They require repeated trips to doctor’s offices for treatment and other tests. This can impose a large economic and time burden. Experts are studying the cost-effectiveness of these treatments against other care options. Discuss your treatment priorities with your doctor.³

Before beginning treatment for Alzheimer’s disease, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.