Alzheimer’s patients divided on costly new drug: a ‘magic pill’ or ‘risk I’m willing to take’
Medicare has proposed limiting coverage of Aduhelm. Key groups representing patients and families are pressing to make it more widely available. Among people facing the disease, the outlook is more nuanced.
If you listen to the nation’s largest Alzheimer’s disease advocacy organizations, you might think everyone living with Alzheimer’s wants unfettered access to Aduhelm, a controversial new treatment.
But you’d be wrong.
Opinions about Aduhelm —also known as aducanumab — in the dementia community are diverse, ranging from “we want the government to cover this drug” to “we’re concerned about this medication and think it should be studied further.”
The Chicago-based Alzheimer’s Association and UsAgainstAlzheimer’s — the most influential advocacy organizations in the field — are in the former camp.
Both are pushing for Medicare to cover Aduhelm’s $28,000 annual cost and fiercely oppose the federal Centers for Medicare & Medicaid Services’ January proposal to restrict coverage only to people enrolled in clinical trials. Nearly 10,000 comments were received on that proposal, and a final decision is expected in April.
“With respect, we have no more time for debate or delay,” the Alzheimer’s Association’s national Early-Stage Advisory Group wrote in a Feb. 10 comment. “Every passing day without access to potential treatments subjects us to a future of irreversible decline.”
UsAgainstAlzheimer’s called CMS’ proposal “anti-patient.”
Yet the scientific evidence behind Aduhelm is inconclusive, its efficacy in preventing the progression of Alzheimer’s remains unproved, and there are concerns about its safety.
The FDA granted accelerated approval to the medication last June but ordered the drugmaker, Biogen, to conduct a new clinical trial to verify its benefit. And the agency’s decision came despite a 10-0 recommendation against doing so from its scientific advisory committee, with one abstention by a member citing uncertainty.
Other organizations representing people living with dementia are more cautious, calling for more research about Aduhelm’s effectiveness and potential side effects.
More than 40% of people who take the medication have swelling or bleeding in the brain — complications that need to be carefully monitored.
The Dementia Action Alliance, which supports people living with dementia, is among them. In a written statement via Karen Love, its chief executive officer, the organization said, “DAA strongly supports CMS’s decision to limit access to aducanumab to people enrolled in qualifying clinical trials in order to better study aducanumab’s efficacy and adverse effects.”
Dementia Alliance International — which, with more than 5,000 members, is the world’s largest organization run by and for people with dementia— has not taken a position on Aduhelm.
“We felt that coming out with a statement on one side or another would split our organization,” said Diana Blackwelder, its treasurer, who lives in Washington, D.C.
“To say that millions of people afflicted with a disease are all up in arms against CMS’s proposal is just wrong,” said Blackwelder, 60, who was diagnosed with early-onset Alzheimer’s in 2017. “We’re all individuals, not a collective.”
“I understand the need for hope,” she said, expressing a personal opinion. “But people living with dementia need to be protected as well. This drug has very serious, frequent side effects. My concern is that, whatever CMS decides, they at least put in some guardrails so that people taking this drug get proper workups and monitoring.”
The debate over Medicare’s decision on Aduhelm is crucial since most people with Alzheimer’s are older or seriously disabled and covered by the government health program.
Here’s some of what several people living with dementia think:
Jay Reinstein, 60, is married and lives in Raleigh, North Carolina. He was diagnosed with early-onset Alzheimer’s disease three years ago and formerly served on the national board of directors of the Alzheimer’s Association.
“I understand [Aduhelm] is controversial, but, to me, it’s a risk I’m willing to take because there’s nothing else out there,” Reinstein said, noting that people he’s met through support groups have progressed in their disease very quickly. “Even if it’s a 10% chance of slowing [Alzheimer’s] down by six months, I am still willing to take it. While I am progressing slowly, I want more time.”
Laurie Scherrer of Albertville, Alabama, was diagnosed with early-onset Alzheimer’s and frontotemporal dementia in 2013 when she was 55.
Early on, Scherrer was prescribed Aricept (donepezil), one of a handful of medications that address Alzheimer’s symptoms.
“I became totally confused and disoriented,” she said. “I couldn’t think. I couldn’t concentrate.”
After stopping the medication, those symptoms went away, she said.
“I am not for CMS approving this drug, and I wouldn’t take it,” Scherrer said.
At discussion groups on Aduhelm hosted by the Dementia Action Alliance — for which Scherrer is a board member — only two of 50 participants wanted the drug to be made widely available. The reason, she said: “They don’t think there are enough benefits to counteract the possible harms.”
Rebecca Chopp, 69, of Broomfield, Colorado, was diagnosed with early-onset Alzheimer’s in March 2019.
Chopp, a former chancellor of the University of Denver, is a member of a newly formed group of five people with dementia who meet regularly, “support one another” and want to “tell the story of Alzheimer’s from our perspective,” she said.
Two people in the group have taken Aduhelm, and both report that it has improved their well-being.
“I believe in science, and I am very respectful of the large number of scientists who feel that [Aduhelm] should not have been approved,” Chopp said. “But I’m equally compassionate toward those who are desperate and who feel this might help them.”
Chopp opposes CMS’ decision because “Aduhelm has been FDA-approved, and I think it should be funded for those who choose to take it.”
Joanna Fix, 53, of Colorado Springs, Colorado, was diagnosed with early-onset Alzheimer’s disease in October 2016. She, too, developed serious complications after taking Aricept and another dementia medication, Namenda (memantine).
“I would love it if tomorrow somebody said, ‘Here’s something that can cure you,’ ” Fix said. “But I don’t think we’re at that point with Aduhelm. We haven’t been looking at this [drug] long enough. It feels like this is just throwing something at the disease because there’s nothing else to do.
“Please, please take it from someone living with this disease,” Fix said. “There is more to life than taking a magic pill. All I care about is my quality of life. My marriage. Educating and helping other people living with dementia. And what I can still do day to day.”
Phil Gutis, 60, of Solebury, Pennsylvania, has participated in clinical trials and taken Aduhelm for five and a half years after being diagnosed with early-onset Alzheimer’s in 2016.
Gutis is convinced the medication has helped him.
“I don’t know how to describe it other than to say my head feels so much clearer now,” he said. “I feel much more capable of doing things now. It’s not like I’ve gained my memories back, but I certainly haven’t deteriorated.”
Gutis thinks CMS’ proposed restrictions on Aduhelm are misguided.
“When the FDA approved it, there was this sense of excitement — oh, we’re getting somewhere,” he said. “With the CMS decision, I feel we are setting the field back again. It’s this constant feeling that progress is being made and then — whack.”
Christine Thelker, 62, is a widow who lives alone in Vernon, British Columbia. She was diagnosed with vascular dementia seven years ago and is a board member for Dementia Advocacy Canada, which supports restrictions on Aduhelm’s availability.
“Most of us who live with dementia understand a cure is not likely,” Thelker said. “There are too many different types of dementia, and it’s just too complicated. To think we’re just going to take a pill and be better is not realistic. Don’t give us false hope.”
What people with Alzheimer’s and other types of dementia need instead, Thelker said, is “various types of rehabilitation and assistance that can improve our quality of life and help us maintain a sense of hope and purpose.”
Jim Taylor of New York City and Sherman, Connecticut, is a caregiver for his wife Geri Taylor, 78, who has moderate Alzheimer’s. She joined a clinical trial for Aduhelm in 2015 and has been on the drug since, with the exception of about 12 months when Biogen temporarily stopped the clinical trial.
“In that period, her short-term memory and communications skills noticeably declined,” Jim Taylor said.
“We’re convinced the medication is a good thing, though we know it’s not helpful for everybody,” Taylor said. “It really boosts [Geri’s] spirits to think she’s part of research and doing everything she can.”
“If it’s helpful for some, and it can be monitored so that any side effects are caught in a timely way, then I think [Aduhelm] should be available. That decision should be left up to the person with the disease and their care partner.”