Alzheimer's Drug Stirs Hope For Patients, Worry For Doctors
In the weeks since a new Alzheimer's drug was approved, hopeful patients have bombarded Dr. Alireza Atri with calls and emails about a treatment that has sparked both excitement and skepticism. They want to know if the drug might be right for them. Like many physicians, Atri has no easy answers.

It probably won't be for a while. Doctors across the country are still trying to figure out who should receive the drug called Aduhelm, which, at best, slows the fatal disease marginally. Other drugs for Alzheimer's disease only temporarily ease symptoms like memory problems, insomnia and depression.

Karl Newkirk hopes to start taking Aduhelm if his doctor gives the OK because he doesn't see any other treatments worth trying. Newkirk's doctor confirms he's a good candidate for the drug. He wants to try Aduhelm, even though he's aware of the drug's limits. Michele Hall, 54, of Bradenton, Florida, also is eager to discuss the drug at her next appointment with an Alzheimer's specialist. She calls Aduhelm the first tiny glimmer of hope.

Biogen's Aduhelm is the first Alzheimer's medication in nearly 20 years. Its FDA approval triggered a swift backlash from many experts, including the agency's own outside advisers who had warned that its supposed benefit relied on flimsy data. Three resigned over the FDA's decision.

Aduhelm does not reverse mental decline. It only slowed it in one study that was marred by hard-to-interpret results. The data were so murky that the FDA ultimately granted the drug conditional approval based on a different measure: it's ability to get rid of harmful clumps of plaque in the brains of patients with early forms of the disease.

The FDA approval isn't limited to those early patients. Anyone with Alzheimer's - at least theoretically - could get prescribed the drug. But advocacy groups like the Alzheimer's Association and many doctors say the focus should be patients with an early diagnosis, like those helped in the study.

About 40% of patients getting the full drug dose in Biogen's studies had swelling or tiny bleeds in the brain. While the side effects usually resolved, in rare cases they led to more severe bleeding that could potentially cause brain injury or other dangerous complications. Monitoring patients on the drug involves regular brain scans. That's on top of a different type of scan to tell if patients have the brain plaque targeted by the drug. Running all those tests could easily approach $10,000 the first year, according to physicians.

The private Michigan Institute for Neurological Disorders has already started treating early-stage Alzheimer's patients. Meanwhile, Stanford's Greicius, a neurologist and Alzheimer's specialist, has no plans to prescribe Aduhelm. He said he plans to lay out a "compelling and compassionate" case for why he doesn't want to give patients the medicine. But he worries that some patients may simply turn to a doctor who will provide it.

One likely consequence of Aduhelm's approval is earlier screening and diagnosis for Alzheimer's, a longtime aim of those who study the disease, given that it develops slowly over years or decades.