Pharmacists Can Help Patients Navigate Current Treatment Landscape of Alzheimer Disease

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Alzheimer disease (AD) is a progressive neurodegenerative disease that is characterized by memory loss, cognitive decline, and eventually, functional impairment. The progression of the disease is viewed as a continuum and characterized as mild cognitive impairment (MCI), as well as mild, moderate, and severe dementia stages. Additionally, the pathological process of AD with amyloid-beta (Aβ) and tau deposition in the brain begins about 10 to 20 years prior to symptom onset, and these can be diagnosed based on the presence of amyloid plaques and tau neurofibrillary tangles within the brain.¹

Previously, the available treatments for AD included acetylcholinesterase inhibitors and memantine, which are used to treat both cognitive and behavioral symptoms in the dementia stage of AD; however, these are likely to not alter the disease’s trajectory. As the understanding of the molecular mechanisms behind AD’s pathophysiology, disease-modifying treatments (DMTs) have been under development and clinically proven to be effective. Currently, the 3 FDA-approved DMTs for clinical use as Aβ-targeting therapies (ATTs) are aducanumab (Aduhelm; Biogen), lecanemab (Leqembi; Biogen, Eisai Co, Ltd), and donanemab (Kisunla; Eli Lilly and Co), all of which target 3 different variants of Aβ.¹

Patients will often have to undergo laboratory tests, MRIs, cerebrospinal fluid (CSF) tests, or positron emission tomography (PET) scans to help make diagnoses. For most, the diagnostic pathway will begin with health care professionals, who will assess patients on their clinical symptoms and medical history, conduct cognitive assessments (eg, Mini-Mental State Examination [MMSE]), physical examinations, and laboratory tests to rule out other health conditions.^1,2

Additionally, pharmacists may frequently check in with patients and assess their symptoms during interactions, providing early screening and identification of MCI. Accessing diagnostic tests or making appointments at memory specialist or primary care offices can be difficult or take extensive periods of time, and monitoring and interacting with patients as well as collaboration between pharmacists and health care professionals can be significant for timely, accurate AD diagnoses. Following diagnosis, pharmacists can also educate patients on their treatment options or address any concerns they may have.^1,2

Challenges of these ATTs include their intravenous (IV) infusion mode of administration, which can be difficult on patients and health care professionals. Lecanemab, for example, requires biweekly infusions whereas donanemab is administered every 4 weeks and can be discontinued based on amyloid reduction. Currently, the weekly administration of subcutaneous lecanemab is undergoing evaluation in clinical trials, and if safe and effective, the subcutaneous administration may reduce burdens associated with IV infusions. Further, subcutaneous administration methods may also be more accessible to patients if they were to become available in pharmacies rather than primary care or specialist offices. These health care professionals have limited time to dedicate to each patient, making it difficult to offer patients the highest quality of care.¹

To effectively implement DMTs in real-world settings, experts recommend that establishing treatment guidelines, training health care professionals, conducting follow-up studies and investing in patient registry, as well as the consideration of combination therapies can be viable solutions. Developing clear inclusion and exclusion criteria can ensure that the patients who need these treatments the most are receiving them. Further, education can help health care professionals provide the necessary skills to interpret biomarker test results, communicate them with patients, recognize treatment adverse events (AEs), and notice potential indicators of cognitive impairment during interactions. Characterizing patient subgroups and investing in clinical study registries can help better identify patients who benefit from certain treatments and optimize AD care going forward.¹

Pharmacists also play a key role in ensuring patients are receiving the correct medications and that there are no drug-drug interactions. Additionally, they can provide guidance based on patients’ concerns.^1,2

REFERENCE

1. Aye S, Johansson G, Hock C, et al. Point of view: Challenges in implementation of new immunotherapies for Alzheimer's disease. The Journal of Prevention of Alzheimer's Disease. 2025:100022. doi:10.1016/j.tjpad.2024.100022

2. McGovern G. Mild Cognitive Impairment is Extremely Undiagnosed, Expert Says. Pharmacy Times. September 20, 2024. Accessed January 7, 2025. https://www.pharmacytimes.com/view/mild-cognitive-impairment-is-extremely-undiagnosed-expert-says