Immunotherapy in Alzheimer’s disease – new treatment, old problems

Alzheimer’s disease is one of the major challenges of modern medicine. Despite strenuous research and numerous clinical trials, no registered causal treatment exists in Europe; however, such pharmacotherapy is already available in the United States (aducanumab and lecanemab). Positive results of immunotherapy clinical trials in Alzheimer’s disease, both completed and still ongoing, give hope for finding safe substances that would effectively inhibit the development of Alzheimer’s disease (donanemab pending registration or remternetug in the research phase). Failures in the registration of medicines in Europe have their roots in the lack of noticeable therapeutic benefits and, despite everything, relatively serious adverse effects. The high cost of this therapy as well as the lack of trained personnel and easily accessible centres, where the drug could be administered and patient’s condition could be monitored using magnetic resonance imaging, is another problem. Early diagnosis of patients with Alzheimer’s disease before the onset of symptoms of dementia is an old, still unsolved challenge as immunotherapy is designed only for these patients. Widely applicable diagnostic criteria and guidelines have still not solved the problem of late diagnosis in most patients. A large body of evidence indicates that the efficacy of preventive measures and the control of risk factors can significantly reduce the number of patients. Creating an integrated system to adequately care for the rapidly growing number of patients is crucial. Unfortunately, access to specialist diagnostic centres and support networks for the broadly understood post-diagnosis care for patients and their carers is still a matter of the distant future.