While there are a lot of yellow lights flashing, the main drive in research on a pharmacological treatment for Alzheimer's disease -- the magic bullet drug -- has focused on removing amyloid plaques from the brain. Aduhelm, Leqembi, and other prospective amyloid cleaners get nearly all of the attention and a lot of the funding. But there remain questions about their effectiveness, their safety, and their cost. A new study, published in the journal Neurology, has further energized the questions.
The research, "Accelerated Brain Volume Loss Caused by Anti-β-Amyloid Drugs: A Systematic Review and Meta-analysis," abstract available here, correlated data from different brain imaging studies. It found that these amyloid removal treatments led to brain volume loss. Is that a good thing or a bad thing? Is the brain losing tissue because it's getting better, or are the treatments introducing new problems?
The volume loss is associated with a phenomenon called "amyloid-related imaging abnormalities," or ARIA. ARIA include the microhemorrhaging in patients using the monoclonal antibody treatments, like Leqembi, that are suspected to be involved in the deaths of a few patients. And so there is reason for concern.
This has led to controversy. Is it possible ARIA is really evidence that the treatments are working? Or are they actually accelerating neurodegeneration? I'm not equipped to answer that question, but there seem to be strong opinions on both sides. Nevertheless, there's unanimous agreement that more study is necessary. And this all just underscores how little we understand about these things.
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