The Drug:
- Name: Donanemab (Brand: Lormalzi) by Eli Lilly.
- Type: Monoclonal antibody treatment (disease-modifying).
- Admin: Once a month IV infusion.
Mechanism
- Classic sign of Alzheimer's = build-up of 'amyloid-beta' protein plaques in the brain.
- Drug uses lab-made proteins to target and dissolve these plaques.
- Result: Slows cognitive decline by approx 30% in early-stage patients.
- Target group: strictly for early-stage patients (mild cognitive impairment/dementia).
- Limitation: It DOES NOT reverse damage already done. It only slows the progression.
India Context & Disease Burden:
- Current dementia cases in India: ~8.8 million (Projected to hit 16.9 million by 2036).
- Alzheimer's accounts for the vast majority of these dementia cases.
Challenges for Implementation in India
- Cost: Prohibitively expensive (~Rs 91.6k per dose). Company plans an 'access programme', but mass affordability is highly unlikely.
- Diagnosis gap: Treatment requires early diagnosis, which rarely happens in India.
- Health Infra: Needs expensive amyloid PET imaging and strict follow-ups to monitor adverse events.
- Health Risks: brain swelling (24%) and bleeding (19.7%). Patients must be tested for the APOE4 gene first, which is linked to a higher risk of these side effects.
