Syracuse Alzheimer’s clinic has doubts about controversial new drug patients clamoring for

Dr. Sharon Brangman

Dr. Sharon Brangman, chair of geriatrics and director of the Center for Alzheimer's Disease at Upstate University Hospital. Photo by Peter Chen / The Post-Standard.

Syracuse, N.Y. – Upstate University Hospital hasn’t decided if it will prescribe a controversial new Alzheimer’s drug many of its patients are clamoring for.

Upstate’s Center of Excellence for Alzheimer’s Disease, which treats more than 3,000 patients annually, has been swamped with calls from patients and families since the FDA last week approved Aduhelm, the first new drug to treat the incurable brain disease in 18 years.

“People are desperate for something that works,” said Dr. Sharon Brangman, the center’s director.

But Brangman said she and her colleagues aren’t sure if it makes sense to give Aduhelm to patients because of significant doubts about whether the drug, priced at $56,000 a year, works.

The FDA approved the drug even though its outside panel of experts said there wasn’t enough evidence to show the medication made by Biogen slowed the disease’s progression. Three scientists resigned from the committee in protest after the FDA approved the drug June 7.

Alzheimer’s is an incurable, progressive brain disease that destroys memory and other important mental functions. It primarily affects people over 65. An estimated 6.2 million Americans have Alzheimer’s, including 410,000 in New York state.

Many people with Alzheimer’s have clumps of amyloid plaque, a type of protein, in their brains. Aduhelm is supposed to help slow the progression of the disease by removing some of that plaque. Scientists, however, have not proven that the plaque causes the disease. Some Alzheimer’s patients don’t have the plaque in their brains.

“Currently available therapies only treat symptoms of the disease; this treatment option is the first therapy to target and affect the underlying disease process of Alzheimer’s,” the FDA said when it announced the approval.

There’s been a lot of pressure on the FDA from patient groups anxious for new Alzheimer’s treatments.

The Alzheimer’s Association called the approval of Aduhelm a “victory for people living with Alzheimer’s and their families.”

Biogen halted two studies of the drug in 2019 after disappointing results suggested the drug would not meet its goal of slowing mental and functional decline in Alzheimer’s patients. Several months later, the company reversed course, announcing that a new analysis of one of the studies showed the drug was effective at higher doses and that the FDA had advised that it warranted review.

The Upstate center has a team of geriatricians, pharmacists, nurse practitioners and social workers who work with Alzheimer’s patients from a 15-county region.

“We don’t want to deprive anyone of excellent treatment and care,” Brangman said. But the center also doesn’t want to foster false hope in patients.

“We want to help people manage expectations,” Brangman said. “This is not a cure. We need more information so we can help them make a good decision.”

Even though Biogen only tested the drug on Alzheimer’s patients with mild cognitive impairment, the FDA approved it for all Alzheimer’s patients.

Brangman said it’s unknown if the drug will help patients with moderate and advanced cognitive impairment.

Brangman is also concerned about the drug’s $56,000 price. That cost doesn’t include expensive MRI brain scans patients on the drug will have to get. It’s not known yet how much of the drug’s costs will be covered by Medicare and other insurers.

“My concern is, is this a drug that will be available to everyone?” she said.

Brangman also is troubled because few African-American, Asian and Latino patients were included in the study of the drug. “That’s a big concern because we take care of a very diverse group of patients,” she said.

Aduhelm also has side effects. In two trials 40% of patients experienced painful brain swelling and about 17% experienced small brain bleeds.

“We have to help families make a decision about taking a medication to which we don’t have all the answers yet and balance that with all the side effects,” Brangman said.

James T. Mulder covers health and higher education. Have a news tip? Contact him at (315) 470-2245 or jmulder@syracuse.com

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