New Dementia Therapies – Dilemmas, Decisions and Dollars

Leading researchers and representatives from the health sector convened at the Australian Dementia Research Forum 2024 to discuss the challenges and opportunities in implementing new disease modifying therapies for Alzheimer’s disease in Australia.

Moderator and Director of the Australian Dementia Network, Professor Christopher Rowe, said, “The development of disease modifying therapies (DMTs) for Alzheimer’s disease has considerably progressed over the last decade. For the first time we have therapies with the potential to slow down Alzheimer’s disease progression. This could provide life-changing opportunities for people living with AD and their families. However, they come with major dilemmas due to large unmet need, prohibitive costs, side effects, etc”.

Ms Eliza Strapp, First Assistant Secretary, Department of Health and Aged Care, and Co-chair of the session, noted that the topic was very complex given the opportunities and dilemmas that all new treatments bring. She noted that “if approved, these treatments present several challenges for the health system, from identifying patients who will benefit from them, addressing capacity constraints, monitoring safety and efficacy and the always important questions about dollars”.

From L-R: Mr Glen Pang, Ms Eliza Strapp, Professor Chris Rowe, Dr Cathy Short, Professor Stephen Salloway

Dr Cathy Short, a Cognitive Neurologist working within the Central Adelaide Local health network expressed optimism about the simultaneous development of new amyloid therapeutics and diagnostic blood tests, which could facilitate early diagnosis. She cautioned, however, that the rollout of new therapies would place significant strain on health services, particularly in patient access to a shortage of dementia specialists amid a growing number of referrals. Expectations need to be managed as a large number of patients will miss out on the treatment, due to strict inclusion and exclusion guidelines to keep patients safe, and that even for those that do qualify for the treatment, questions remain around sufficient infrastructure, particularly infusion centre spaces and the regular monitoring necessary for possible amyloid-related imaging abnormalities (ARIA). The side effects, although largely manageable, can and have been fatal.

Mr Glen Pang, Manager of the Aged Health Network, Agency for Clinical Innovation from NSW, highlighted three things that need attention: a flexible and scalable plan, staged approach that matches our current resources, broad stakeholder engagement. “We explore opportunities to align with other initiatives not work in silos,  learn from multiple sclerosis and thrombolysis”

Dr Stephen Salloway, an internationally recognized leader in clinical trials for AD prevention and treatment noted, “this is a transformative moment and almost revolutionary to think of Alzheimer’s as a treatable disease”. He emphasised the opportunities for innovation in Australia to deliver the best care possible. For instance, training nurse practitioners to administer and monitor monoclonal antibodies, enriching primary care and tracking real-world experience through registry to ensure treatments are safe.

There was agreement amongst all panellists that conversations need to be had across all various sectors represented, from government, to policy makers, to researchers and health care workers. Mr Pang said, “Take us on the journey with you. Build a coalition of the willing. Think about scale and spread, right from the beginning”.

The Australian Dementia Network expresses gratitude to the panellists:
 
Moderator: Prof. Christopher Rowe MD FRACP FAANMS, Director, Australian Dementia Network, University of Melbourne and Director, Molecular Imaging Research, Austin Health
Co-Chair: Ms Eliza Strapp, First Assistant Secretary, Department of Health and Aged Care
Panellists:

Dr Stephen Salloway, Center for Alzheimer’s Disease Research, Brown University
Dr Cathy Short, Neurologist, Department of Neurology, The Queen Elizabeth and Royal Adelaide Hospitals
Mr Glen Pang, NSW Health