If you’re reading this, you’ve got about an 11% chance of having Alzheimer’s disease at age 65 or older. If you were assigned male at birth, your odds of developing this most common type of dementia by age 45 are one in 10, according to the Alzheimer’s Association. For women, the odds at 45 are even more harrowing: one in five. And that’s without a family history of the disease.
While the Food and Drug Administration has in recent years approved drugs such as Leqembi (lecanemab-irmb) and Kisunla (donanemab-azbt) to treat adults in the mild dementia stage of Alzheimer’s, they only slow disease progression. Researchers at the Washington University School of Medicine in St. Louis are testing a preventive medication in patients as young as 18, in the hope of stopping Alzheimer’s decades before symptoms may appear.
The international Primary Prevention Trial will enroll roughly 250 young adults at high risk of developing early-onset Alzheimer’s, which may appear in a person’s thirties, forties, or fifties. Participants must have a family member who has a mutation in any of three genes linked to early-onset Alzheimer’s: APP, PSEN1, and PSEN2. Because children who inherit such mutations tend to show signs of dementia around the same age their parents did, the trial is enrolling people 11 to 25 years before they anticipate becoming symptomatic.
Hannah Richardson is among the participants in the two-year clinical trial. The 24-year-old’s family history of Alzheimer’s goes back generations.
“My grandfather passed away from Alzheimer’s, and so did his mother and all but one of his brothers,” Richardson said in a Feb. 4 news release about the research. “My mom and my uncle have been participating in DIAN (Dominantly Inherited Alzheimer Network) trials since I was about 10 years old.
“My mom was always very open about her diagnosis and how it spurred her advocacy for Alzheimer’s research, and I’ve always known I wanted to follow in her footsteps. I am happy to be involved in the Primary Prevention Trial and be involved in research, because I know how important it is.”
Fortune 500 firms compete in Alzheimer’s research
Richardson and her fellow participants will be assigned to take either a placebo or an investigational drug called remternetug, developed by Fortune 500 pharmaceutical firm Eli Lilly & Co. It’s a monoclonal antibody that can be injected under the skin every three months, whereas currently available treatments must be administered intravenously every two to four weeks.
Alzheimer’s disease develops when abnormal levels of a protein fragment called beta-amyloid build up in and around brain cells. The resulting clumps are called amyloid plaques, which may not cause symptoms for 20 or so years. The FDA-approved Kisunla, also manufactured by Lilly, and Leqembi, made by Eisai and Fortune 500 company Biogen, work by fighting amyloid plaques.
“We are pleased to partner with the DIAN [Trials Unit] team to evaluate whether remternetug can help slow or prevent the accumulation of amyloid plaque, a defining event in the early cascade of Alzheimer’s disease onset,” Dr. Mark Mintun, group vice president of neuroscience research and development at Lilly, said in the news release.
When WashU Medicine began the Primary Prevention Trial in 2021, researchers had planned to use an experimental drug called gantenerumab, produced by Genentech and Fortune 500 Europe firm Roche. However, the companies discontinued its development because of poor performance in other clinical trials.
Trial participants who carry one of the genetic mutations associated with early-onset Alzheimer’s may opt to receive treatment with remternetug for four years of extended study.
“We have seen tremendous progress in the treatment of Alzheimer disease in the past few years,” Dr. Eric McDade, a WashU Medicine professor of neurology and the trial’s principal investigator, said in the news release. Leqembi and Kisunla, he added, provide “strong support for our hypothesis that intervening when amyloid beta plaques are at the very earliest stage, long before symptoms arise, could prevent symptoms from emerging in the first place.”
For more on dementia:
- It’s not just forgetfulness: 8 early warning signs of dementia
- Medicare has a new pilot program to help people with dementia. Here’s how it works
- 5 ways to reduce your dementia risk as study estimates U.S. cases could double by 2060
- Does Medicare pay for dementia care? Here’s what coverage you can expect for treatments and therapies
- Belly fat tied to brain health in middle-aged adults at high risk of Alzheimer’s, study finds—but it’s worse for men
