Alzheimer’s drug — how big a deal?

Eli Lilly announced that its experimental anti-beta-amyloid drug donanemab cleared away brain plaque while patients “showed 35% less decline in thinking skills compared to those given a dummy drug.”

This is obviously big news. It doesn’t just show a chemical benefit, but a life-changing one. Approval may come later this year or early 2024; pricing hasn’t been set.

Caveats:

• The info was only in a press release, not trial results, so experts haven’t had a chance to pore over the details.
• At least two trial participants died, likely due to the drug. Will that deter patients? Probably not, but it might affect approval.
• On that same note, similar drugs have been linked to brain damage and other nasty side effects.
• The slowing of cognitive decline was important because it’s still not clear how much of a role beta-amyloid or tau plaques actually play in the disease.

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Alzheimer’s: Beyond drugs

Go online, old man

An NYU study of 18,000 patients for up to 17 years found that, while 4.68% of participants were eventually diagnosed with dementia, “Regular internet usage was associated with approximately half the risk of dementia compared with non-regular usage. This link was found regardless of educational attainment, race-ethnicity, sex, and generation.”

… then go to sleep

A simple way to fight Alzheimer’s memory loss might be to get a good, deep sleep, at least according to UC Berkeley researchers.

Deep sleep, also known as non-REM slow-wave sleep, can act as a “cognitive reserve factor” that may increase resilience against a protein in the brain called beta-amyloid that is linked to memory loss caused by dementia.

In case that wasn’t clear, they provided this not-terribly helpful image:

Beta blockers may not make a difference

After a heart attack, the standard treatment is long-term beta blockers to prevent another. But — Swedish researchers say — that might be unnecessary as long as the patient doesn’t have heart failure.

They looked at the data for almost 44,000 people, 21% of whom weren’t prescribed beta blockers after a heart attack (i.e., the sample size was pretty darned good). Their finding:

The real time data showed that long term treatment with beta blockers wasn’t associated with improved cardiovascular outcomes during an average monitoring period of 4.5 years.

The difference was tiny:

• On beta blockers: 19% had another major heart problem
• Not on beta blockers: 22% had another major heart problem

“And after accounting for potentially influential factors […] there was no discernible difference in the rates of these events between the two groups.”

Link above is to the news story. The editorial in Heart is here (2-page PDF) and the paper itself is here (18-page PDF).

Weight-loss drugs in the news (again)

It’s a small(er) world after all

“Weight-loss drugs. There must be a new negative we can focus on,” said^* the editors of the Atlantic. “We’re supposed to be the World’s Most Depressing Magazine™.”

“I know!” said^* staff writer Sarah Zhang. “How about a story on how Ozempic can ruin a Disney vacation?”

“But Disney vacations are already nightmares if you’re over 12.”

“Yes, but Ozempic can make it worse.”

“You have our attention.”

Presenting: “Can You Have a Fun Vacation on Ozempic?”

^* Not really. Well, probably not. 

Speaking of Ozempic downsides…

Knowing the demand, makers of these drugs have set the price way, way high — and that means higher insurance premiums for employers if their plans cover the drugs.

Semaglutide — sold under the brand names Ozempic, Wegovy and Rybelsus — ranked fourth for total drug expenditures in the U.S. in 2021 at $10.7 billion, up 90% over the year before.

Some insurers have set up “gatekeeping tools” like BMI requirements or step therapy as, unlike bariatric surgery, these drugs aren’t once-and-done — they have to be paid for every month. That’s likely to be even more common as more GLP-1 drugs are approved.

Novo holds back supply

Novo Nordisk, is limiting new doses of Wegovy to existing patients — i.e., it won’t sell starter kits —“to ensure a steady supply for people already on the medication.”

Elsewhere: Drug drones to deliver

The University of Michigan’s Michigan Medicine is going to start (testing) drug delivery by drone next year, at least to patients within a 10-mile radius of one of its facilities.

The drones “will silently hover 300-feet above the ground” and lower their packages “on a tether that precisely delivers to their doorstep or balcony or other place of choice from the patient.”