Latest / Morning Medical with Dr. Chow / New Alzheimer's Drug Donanumab: Approval, Trials, and Challenges

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New Alzheimer's Drug Donanumab: Approval, Trials, and Challenges · Morning Medical with Dr. Chow

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Good morning, and welcome to another episode of Morning Medical with Dr.
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Chow.
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I'm your host, Dr.
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Chi-Ming Chow.
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Today, we have a packed schedule touching on the latest medical and health news from around
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the world.
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From new treatments for Alzheimer's disease to strategies for quitting smoking and tips for
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treating common summer injuries in kids, we have a lot to cover.
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Let's dive right in.
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The United States Food and Drug Administration has approved a new Alzheimer's drug, offering
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hope for those in the early stages of this debilitating disease.
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The drug, known as Donanemab and marketed under the name Kysimla, has been developed by Eli
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Lilly and Company.
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This approval makes it the second drug that has been convincingly shown to slow the progression
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of Alzheimer's disease, following last year's approval of Leqembi from the Japanese drugmaker
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Eisai.
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The approval of Kysimla is particularly significant for patients with mild or early
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cases of dementia caused by Alzheimer's.
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The new drug works by targeting amyloid plaques in the brain, which are believed to contribute
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to the disease's progression.
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In clinical trials, patients who received Donanemab experienced a decline in memory and
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cognitive abilities about 22% more slowly than those who received a placebo.
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On average, this translates to a delay of about seven months in the disease's progression.
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However, the drug is not without its downsides.
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Regular intravenous infusions are required, and there are potentially dangerous side effects,
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including brain swelling and microbleeds.
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In the clinical study, approximately 20% of patients experienced microbleeds, a slightly
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higher rate than what was observed with Leqembi.
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Despite these risks, many health care professionals see the approval as a crucial
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step forward.
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"I'm thrilled to have different options to help my patients," said Dr.
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Suzanne Schindler, a neurologist at Washington University in St.
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Louis.
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"It's been difficult as a dementia specialist.
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I diagnose my patients with Alzheimer's, and then every year, I see them get worse and they
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progress until they die."
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Both donanemab and Leqembi are laboratory-made antibodies that are administered by intravenous
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infusion.
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These drugs target amyloid plaques, one of the contributors to Alzheimer's disease.
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However, questions remain about which patients should receive these drugs and how long they
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might benefit from them.
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The approval of donanemab was expected after an outside panel of Food and Drug Administration
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advisors unanimously voted in favor of its benefits at a public meeting last month.
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This endorsement came despite several questions from Food and Drug Administration reviewers
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about how Eli Lilly studied the drug, including allowing patients to discontinue treatment once
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their brain plaque levels became very low.
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One of the potential advantages of Donanemab over Leqembi is its dosing regimen.
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Donanemab is infused once a month compared to Leqembi's twice-a-month schedule.
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This could be more convenient for caregivers who need to bring their loved ones to a
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hospital or clinic for treatment.
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Additionally, patients can stop taking Donanemab if they respond well to the
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treatment.
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In the company's study, more than 40 percent of patients discontinued the drug after one year
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because their brain plaque levels had decreased significantly.
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However, it is not yet clear when patients might need to resume the infusions.
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Logistical challenges and financial concerns have slowed the rollout of these new
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Alzheimer's drugs.
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Many smaller hospitals and health systems are not yet set up to prescribe these treatments.
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Doctors need to confirm that patients with dementia have the amyloid plaques targeted by
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the drugs, which requires specialized imaging.
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Furthermore, infusion centers need to be available, and nurses and other staff must be
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trained to monitor patients for side effects like brain swelling or bleeding.
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Those are all things a physician has to have set up, said Dr.
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Mark Mintun, who heads Eli Lilly's neuroscience division.
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Until they get used to them, a patient who comes into their office will not be offered
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this therapy.
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The cost of Kasunla is another factor to consider, priced at $6,950 United States
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dollars per vial.
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The total cost for a 12-month treatment is around $32,000 United States dollars.
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This cost, combined with the need for regular monitoring and potential side effects, presents
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significant challenges for widespread adoption of the drug.
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Despite these hurdles, the approval of Kasunla represents a meaningful advancement in the
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fight against Alzheimer's disease.
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While it is not a cure, it offers a new option for slowing the progression of this devastating
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condition.
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Patients and their families will need to carefully weigh the benefits and risks, but
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having more treatment options is undoubtedly a positive development.
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Switching gears now to a topic that affects millions of people worldwide, smoking
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cessation.
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The World Health Organization has just released its first-ever clinical treatment guideline for
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individuals who want to quit using tobacco products.
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This is a significant milestone in the global effort to combat tobacco-related diseases.
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The new guidelines are aimed at all adults who are looking to give up any type of tobacco
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product, including cigarettes, water pipes, smokeless tobacco products, cigars,
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roll-your-own tobacco, and heated tobacco products.
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These recommendations are designed to be utilized by health care workers to provide
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effective support for tobacco cessation.
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According to the World Health Organization's director-general, Tedros Adhanom Ghebreyesus,
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this guideline marks a crucial milestone in the global battle against these dangerous products.
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It empowers countries with the essential tools to effectively support individuals in quitting
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tobacco and alleviate the global burden of tobacco-related diseases.
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Rob Cunningham, a senior policy analyst with the Canadian Cancer Society, also emphasized
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the importance of these guidelines.
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He stated, these guidelines provide recommendations that can be implemented
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Canada-wide in all provinces to strengthen cessation initiatives.
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The more we can do for tobacco cessation, the more we're going to have an impact to reduce
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the devastating burden of tobacco use on health.
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The World Health Organization estimates that over 60 percent of the world's tobacco users,
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which amounts to roughly 750 million people, want to quit.
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For those who smoke and are interested in quitting, the World Health Organization
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strongly recommends treatments such as varenicline, nicotine replacement therapy,
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bupropion, and cytisine.
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For smokeless tobacco users, varenicline and nicotine replacement therapy are recommended.
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The agency also urges countries to provide these treatments at no or reduced cost to
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improve accessibility, particularly in low- and middle-income countries.
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In addition to medication, behavioral support is crucial.
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This can include brief advice from health care providers that lasts between 30 seconds to
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three minutes and various counseling options for those interested in quitting.
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Digital interventions are also encouraged as supplementary measures.
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These can include text messaging, smartphone apps, artificial intelligence, and internet
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programs.
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According to Rob Cunningham, digital techniques may be especially beneficial for younger people
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who are more tech-savvy.
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It is important to note that the World Health Organization did not recommend vaping products
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as a cessation strategy due to the potential risks associated with them.
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Most e-cigarettes and vaping products contain nicotine, which is a stimulant drug found in
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tobacco.
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Health Canada has warned that vaping nicotine can lead to physical dependence and addiction
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and can expose users to harmful chemicals.
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On top of clinical measures, policy interventions such as tobacco taxes and
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subsidizing nicotine replacement products can also make a significant difference in curbing
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tobacco use.
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Last year, Canada became the first country in the world to require warning labels on
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individual cigarettes.
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Health Canada has set a target of reducing tobacco use in the country to under 5 percent
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by 2035. Globally, tobacco use is
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2035. Globally, tobacco use is on the decline.
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A World Health Organization report published in January showed that an estimated 1.25 billion
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people age 15 and older, or 1 in 5 people on the planet, used tobacco in 2022.
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This is down from 1.36 billion people, or 1 in 3, in the year 2000.
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In Canada, roughly 11.4 percent of people aged 15 years and older, or 3.7 million individuals,
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used tobacco in 2022.
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This is a decrease from 2010 when 18.8 percent of that age group used tobacco.
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The World Health Organization predicts that Canada will cut its tobacco use by 44 percent
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next year compared to the year 2000.
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However, the struggle to quit smoking is immense.
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Rüdiger Krech, director of health promotion at the World Health Organization, stated the
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immense struggle that people face when trying to quit smoking cannot be overstated.
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We need to deeply appreciate the strength it takes and the suffering endured by individuals
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and their loved ones to overcome this addiction.
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In another report published in May, the World Health Organization warned that the global
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tobacco industry is using manipulative tactics to aggressively target and hook youth on
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smoking across the globe.
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The agency has called for a ban on the sale of tobacco and nicotine-related products to
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minors.
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For kids, summer can revolve around playgrounds, pools, bikes, and just being
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outside.
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For parents, it can mean a litany of aches to take care of, including scrapes, sunburns, and
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dehydration, pediatricians say.
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Kids should play and have every opportunity to use their imagination, but we need to take
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precautions to keep them as safe as possible, said Doctor Danielle Mercurio, a pediatrician
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at Johns Hopkins All Children's Hospital.
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Here are the top things pediatricians say you should keep an eye on.
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It is important to take precautions in warmer weather, especially with younger kids who are
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more susceptible to heat illness, Doctor Mercurio said.
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That means keeping a water bottle with them outside, wearing sun-protective clothing and
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mineral sunscreen, and not staying in the sun too long.
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Parents also should monitor kids for signs of fatigue and pay attention to the warmth and
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color of their skin.
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If it is red and hot, they probably need to take a break inside or under a shaded area.
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You should also know what the three different types of heat illness are, Dr.
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Mercurio said, each more severe than the next.
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The first is heat cramps, and the only remedy is giving kids fluids that contain electrolytes
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like coconut water or sports drinks to replenish salts that the body lost from
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sweating.
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The next level is heat exhaustion, which causes nausea, vomiting, and feeling weak or anxious.
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A fever typically accompanies it.
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You can try taking the child into a cooler area, giving them fluids, spraying them with
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water, or putting them in front of a fan to cool them off.
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If your child has all of those symptoms and is also acting confused or responding strangely,
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that is heat stroke, which warrants a trip to the hospital.
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Fireworks are fun and bright, but they are not for kids.
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The American Academy of Pediatrics recommends keeping children away from all fireworks.
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Even sparklers can be dangerously hot, said Dr.
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Pojula Souvacone, the University of Chicago's pediatric injury prevention program director.
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He also says to avoid fireworks shows unless they are sponsored by a government agency and
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put on by professionals in a controlled setting.
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Pools, lakes, and other bodies of water are common sites for summertime injuries.
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Dr.
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Souvacone said one must-have, he said, is a designated adult whose only job is monitoring
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the pool while kids are in it.
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If you have an above-ground pool, make sure it is fenced in with four-foot walls to keep kids
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out when there are no adults around.
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Any type of water can be a source of drowning.
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Even an inch can be dangerous for little ones, said Dr.
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Charles and Christina Cratley at Boston Children's Hospital.
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She suggests draining, flipping, and deflating inflatable pools after every use.
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And if a child is rescued from the water and has experienced choking or difficulty breathing
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or lethargy, that might mean there is water in their lungs, and that requires medical
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attention, according to Dr.
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Danielle Grant from Texas Children's Hospital.
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Kids fall off bikes and fall down on trampolines, and they might come back in with
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scrapes and bruises.
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If your kid is on a bike, they should be wearing a helmet.
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Experts say, make sure it fits correctly and the strap is snug under a child's chin.
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Trampoline injuries are common too, especially when there is more than one kid on at a time.
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Parents should make sure that if kids go to a playground, it matches the child's age.
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Dr.
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Cratley said, for example, a little toddler should not be in a large swing that does not
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fit them or climbing tall structures.
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Metal slides can get hot under the sun, so check it before a kid launches down one.
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Most scrapes can be taken care of at home by cleaning them and applying antibacterial
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ointments and bandages, especially if they are not infected.
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But anytime there is a significant fall, especially on the head, take your child to the
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doctor.
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Other warning signs include inability to move an arm, leg, or joint, big cuts, and redness,
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pus, heat, or streaking around a cut or scrape.
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When in doubt, Dr.
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Mau Grant said, call your pediatrician.
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Switching gears now to a fascinating new study that might make city dwellers rethink their
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surroundings.
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A study published in Nature last month has found that living in a city neighborhood rich
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with bird diversity and tree species is linked to increased reports of good mental health.
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This study, conducted by Canadian researchers, offers new insights into how our environment
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can significantly impact our well-being.
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The study found that people living in areas with a greater variety of birds reported
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feeling happier by 6.64%.
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Similarly, those living near a wider range of tree species reported 5.36% higher rates of
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good mental health.
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These increases were seen even when considering other factors like socioeconomic status.
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Rachel Buxton, the study's lead author and assistant professor at the Institute of
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Environmental Science at Carleton University, explained, we found that there was a positive
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association between mental health and the diversity of trees and the diversity of birds
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in people's postcodes.
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Buxton continued.
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There is a whole wealth of other research that shows taking a walk in nature is super good for
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your mental health and your physical health.
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So ours is just one piece of this literature.
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And the story that's saying it's great medicine for your mental and physical health to go
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outside and be in nature.
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In any given year, one in five Canadians experiences a mental illness according to the
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Center for Addiction and Mental Health.
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As the population continues to age and urbanize, it is estimated that within a
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generation, 8,900,000 Canadians will be living with a mental illness, the Mental Health
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Commission of Canada reports.
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While research has shown that neighborhood characteristics and geographic inequalities
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predominantly explain mental health outcomes, especially in urban environments, the
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researchers also found that other factors such as green space can significantly impact mental
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health.
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To explore the link between bird and tree diversity and mental health, the researchers
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analyzed data from the Canadian Community Health Survey from 2007 to 2022 alongside
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information on bird and tree species diversity using eBird, a crowdsourced app, and a national
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forestry inventory.
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They then looked at this data across numerous Canadian cities like Vancouver, Calgary,
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Toronto, and Montreal.
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The researchers specifically focused on birds and trees because they represent a form of
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passive exposure to nature.
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In other words, you can experience these aspects of nature simply by being outside, like
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hanging out on your deck or walking to the bus stop.
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The study found a strong positive correlation between the diversity of birds and trees in a
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neighborhood and self-reported mental health.
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Buxton said, "And it's interesting because there are so many things that influence mental
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health such as your income, education, or marital status.
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But we still found this positive association between the diversity of trees, diversity of
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birds, and people's self-reported mental health.
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And it had around the same effect as eating fruits and vegetables." The link between bird
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and tree diversity and mental health might have roots in our evolutionary past.
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Humans evolved in natural environments, and we evolved in taking our cues from natural
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environments.
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Buxton said, So in an environment where there are lots of different species, so lots of
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different birds and trees, that’s a pretty good indicator that that environment can meet all of
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our needs.
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In an environment rich with bird species and trees, our brain enters what Buxton called rest
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and digest mode, allowing for mental recuperation and restoration from various
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stressors.
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Conversely, in an environment with fewer species, our stress response kicks in,
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triggering the fight or flight mode.
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While the number of street and park trees is estimated to be increasing in Canadian
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municipalities, the researchers argue that the amount of natural forest cover is decreasing.
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Climate change, diseases, and pests are also predicted to increase urban tree mortality.
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Although biodiversity loss is occurring in Canadian cities, Buxton said there are still
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great initiatives underway, such as tree planting, pollination projects, and community
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gardens to help natural environments thrive.
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The study concluded, given the association between tree and bird diversity and self-rated
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mental health at the urban neighborhood level in Canada, holistic nature-based interventions
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that bolster biodiversity can be seen as a key tool for public health planning and policy in
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Canadian municipalities.
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Well, that wraps up today's episode of Morning Medical with Dr.
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Chow.
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Thank you for joining me as we explored the latest advancements in Alzheimer's treatments,
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strategies for quitting smoking, tips for treating common summer injuries in kids, and
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the surprising benefits of living in greener, chirpier urban areas."
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Stay healthy, and stay informed.
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Until next time, I am Dr.
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Chi-Ming Chow signing off.