Reacción a "Reactions: Alzheimer's drug donanemab shows positive results in phase III trial, says drugmaker Eli Lilly"

These results look very impressive, although the side effect profile in terms of high incidence of ARIA remains concerning (to me, both as a Neurologist clinician and a drug developer). 

Certainly, Lilly's Alzheimer's disease Donanemab TRAILBLAZER programmes, which take into account tau levels and the extent of tau dissemination in the cortex, are the best and most well thought out in the field. We have all been waiting for these results with anticipation. Certainly, it looks like the landscape for treating AD (with these amyloid monoclonal antibody amyloid-targeting therapies, including Eisai's lecanumab) is on the cusp of changing clinical practice in this field. However, these therapies will not prevent disease progression ultimately, so ongoing work and development of symptomatic strategies to treat the neuropsychiatric disturbances of Alzheimer's disease dementia is still of the utmost importance - to allow people to live well with Alzheimer's disease dementia and maintain their quality of life and that of their family members and/ or caregivers. 

In addition, it needs to be understood that these therapies are very expensive, require monthly infusions, regular MRI scans to monitor for AEs like ARIAs and the requirement to make a diagnosis of cortical amyloid (and tau) - using PET, which is prohibitively expensive. There are many parts of the world where the diagnostic and therapeutic requirements cannot be met, nor can the cost of the drugs be afforded. And even in the developed world (USA, Western Europe, parts of Asia-Pacific), patients will still require geographical access to a PET scanner and an infusion centre. So it will be interesting to see if/how this creates a significant disparity in access between the wealthy, developed nations (or even regions within a country)  and those parts of the world where this cannot be afforded.