A thorough review highlights progress in disease-modifying therapies, including newly approved anti-amyloid drugs and emerging multi-target approaches for early-stage dementia.
The BMJ has published a clinical review examining recent therapeutic advances in Alzheimer’s disease, spotlighting breakthrough treatments that mark a shift from symptom management to disease modification. The review comes as around 982,000 people across the UK live with dementia, according to the Alzheimer’s Society, with projections suggesting one in six over-80s in England will develop the condition by 2040.
Disease-Modifying Drugs Show Promise
Two anti-amyloid monoclonal antibodies – lecanemab and donanemab – have secured FDA approval for early-stage Alzheimer’s disease in 2023 and 2024 respectively. These treatments target amyloid plaques in the brain and are designed for patients with mild cognitive impairment and mild dementia stages.
Lecanemab demonstrated a 27% slower rate of cognitive decline over 18 months in the CLARITY AD trial, according to FDA data. The drug works by reducing amyloid-beta plaques, one of the hallmark features of Alzheimer’s pathology alongside tau tangles and neuroinflammation.
But the journey hasn’t been without controversy. Aducanumab, another anti-amyloid therapy approved by the FDA in 2021, faced significant debate over its clinical efficacy. Critics have raised concerns about side effects including brain swelling and bleeding, alongside questions over cost-effectiveness and limited long-term data.
Traditional Treatments Remain Cornerstone
Symptomatic treatments continue to form the backbone of current NHS care. Cholinesterase inhibitors – donepezil, galantamine, and rivastigmine – along with the NMDA antagonist memantine, help manage cognitive symptoms across mild to severe dementia stages. These medications received approval between 2001 and 2003 and remain widely prescribed through NHS memory services.
Research Pipeline Expands
The review highlights ongoing research into tau-targeted therapies, including semorinemab and zagotenemab, though none have yet received approval. Scientists are exploring multi-target directed ligands, γ-secretase modulators, stem cell therapies, and neuroinflammation inhibitors as potential future treatments.
Multiple phase II and III trials have failed, especially secretase inhibitors which caused concerning side effects including amyloid-related imaging abnormalities.
UK Access Remains Limited
NICE is currently assessing lecanemab for potential NHS use, evaluating cost-effectiveness alongside clinical benefits. No routine NHS funding exists yet for anti-amyloid drugs as of 2025, leaving patients and families waiting for broader access decisions.
Source: @bmj_latest
Key Takeaways
- Lecanemab and donanemab represent first disease-modifying treatments for early Alzheimer’s, slowing cognitive decline by targeting amyloid plaques
- Traditional symptomatic drugs like donepezil remain standard NHS care for managing cognitive symptoms
- Multiple experimental approaches including tau-targeted and multi-target therapies are in development
What This Means for Kent Residents
Kent residents experiencing memory concerns should seek early diagnosis through GP referral to NHS Kent and Medway Integrated Care Board memory assessment services, as new treatments specifically target early-stage disease. While disease-modifying drugs await NICE approval for NHS funding, symptomatic treatments remain available through local memory clinics alongside support from the Alzheimer’s Society Kent branch. Families can access carer support through Kent County Council adult social care services, with early intervention becoming increasingly important as the treatment landscape evolves.