Experts’ letter calls for individual assessment of new Alzheimer’s treatments in Belgium
An international experts’ letter, co-authored by neurologist Professor Sebastiaan Engelborghs (UZ Brussel/VUB), calls for new Alzheimer’s treatments such as lecanemab and donanemab to be assessed individually in the Belgian reimbursement debate. According to the authors, an overly broad interpretation of existing studies may lead to a distorted view of the effectiveness of these medicines.
The letter, published in the Journal of Prevention of Alzheimer’s Disease, responds to a recent Cochrane review in which several studies on anti-amyloid antibodies were analysed together. Older experimental treatments were grouped alongside more recent therapies that have been studied in patients with biomarker-confirmed early-stage Alzheimer’s disease. According to the authors, this approach makes it more difficult to accurately assess currently available therapies.
The letter was written by several members of the European Alzheimer’s Disease Consortium (EADC), including Professor Sebastiaan Engelborghs, Co-Chair of the EADC and neurologist at UZ Brussel and Vrije Universiteit Brussel, Professor Kristian Steen Frederiksen (Copenhagen) and Professor Frank Jessen (Cologne).
Focus on current treatments
The experts argue that reimbursement decisions should primarily be based on the benefit–risk profile of currently available and approved medicines, rather than on an overall assessment of this therapeutic class that also includes treatments which failed to demonstrate efficacy.
“When evaluating treatments, we must rely on the most relevant evidence. New medicines such as lecanemab and donanemab have been studied in carefully selected patients and have demonstrated an ability to slow disease progression. For patients and their families, this can represent a meaningful difference despite the existing limitations,” says Professor Sebastiaan Engelborghs.
Relevance for Belgium
The timing is particularly relevant for Belgium, where discussions are currently ongoing regarding the potential reimbursement of lecanemab and donanemab. Belgian Alzheimer’s experts recently advocated reimbursement under strict conditions, limited to carefully selected patients with biomarker-confirmed early-stage Alzheimer’s disease and supported by specialised safety monitoring.
Lecanemab and donanemab do not cure Alzheimer’s disease, but studies show that they can slow cognitive decline in people at an early stage of the disease.
The use of this treatment requires careful patient selection, confirmation through biomarkers, and monitoring by specialised teams in order to detect possible side effects early, such as small areas of brain swelling or microbleeds in the brain (ARIA), visible on a brain MRI even before symptoms appear.
Karolien De Prez