The FDA recently granted accelerated approval for a new drug, Lecanemab, which is designed to slow the progression of Alzheimer's disease. The decision has generated much interest and speculation in the medical community regarding its potential impact on healthcare systems and patients worldwide.

According to the World Health Organisation, over 55 million people have dementia globally, with nearly 10 million new cases yearly. Dementia, of which Alzheimer's disease is the most common form, is the seventh leading cause of death globally and a major cause of disability and dependency among older people. The disease is particularly burdensome for women, who provide 70 percent of care hours for people with dementia.

Mayo Clinic neurologist Ronald Petersen, Director of the Mayo Clinic Alzheimer's Disease Research Centre and the Mayo Clinic Study of Aging, notes that Alzheimer's disease is likely the costliest in the US, with an estimated US$300 billion spent per year on direct and indirect costs. “However, the true toll is on the patients and the families,” he explained.

Regarding the new drug, Dr. Petersen said that it is designed to slow down the progression of Alzheimer's disease over time rather than stop or cure it. He emphasised that it is an initial step towards treating a complex disorder like Alzheimer's and noted that combination therapy would likely be necessary to treat the disease effectively.

While the FDA has granted accelerated approval for Lecanemab, the drug is not yet used significantly in the US due to its cost. The FDA will decide on full, traditional approval by July 6, 2023, and the Center for Medicare and Medicaid Services will then decide on coverage.

In the UAE, the prevalence of Alzheimer's disease is estimated to be around 2.2 per cent of the population over 65 years old.  

According to Dr.Petersen, for the past 20 years, physicians have been using symptomatic drugs to treat Alzheimer’s disease.

“We believe that the approval of the recent disease-modifying therapies for Alzheimer's disease is an initial step toward treating these complex disorders,” Dr. Petersen said. “We are hopeful that the future for the treatment of Alzheimer's disease will be bright.”

The approval of Lecanemab represents a significant step forward in treating Alzheimer's disease. While the drug is not yet widely available, its potential impact on patients and healthcare systems worldwide is significant.

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Mental health conditions are a significant global health issue. Research from the World Health Organisation indicates that almost 792 million people worldwide are affected by mental health disorders. It also highlights that one in every eight people lives with a mental illness. 

Despite the widespread prevalence of such concerns, those suffering do not get adequate mental health care. For example, almost 60 per cent of adults with a mental illness do not receive adequate treatment. 

What operates behind inadequate mental healthcare? 

Even though mental health care is essential, several barriers prevent people from accessing adequate mental health care. These include societal stigma, limited access to mental health professionals, and the high cost of treatment. Interestingly, even in a country as advanced as the United States, only 28 per cent of the mental health clinician need is met. 

Fortunately, digital therapeutics (DTx) is emerging as a growing field that offers novel ways to treat mental health conditions and improve patient outcomes. 

What is DTx? 

Digital therapeutics, or DTx, refers to the use of digital technologies, such as mobile apps, to deliver therapeutic interventions for patients. It is quite well received worldwide, and estimates suggest that the global DTx market will reach US$11.82 billion by 2027, with a CAGR of 20.5 per cent from 2020 to 2027.  

As such, DTx has several advantages over traditional forms of therapy. Here are some ways in which digital therapeutics are helping to improve mental health outcomes: 

Accessibility and affordability 

Often, people needing mental health support struggle to access traditional therapy due to geographic or financial barriers. DTx offers a cost-effective alternative that can be accessed from anywhere with an internet connection. This elevates accessibility and affordability.  

Personalised patient care 

Since every individual is unique, their mental health issues also vary. In that sense, personalised treatments are essential for proper outcomes and adequate patient engagement.  
 
DTx offers the advantage of personalising treatment to each individual's unique needs. Leveraging algorithms and data analytics delivers tailored interventions to address specific symptoms, behaviours, and preferences. For example, the DTx product Woebot uses natural language processing and provides users with personalised cognitive behavioral therapy (CBT). 

Continuous monitoring

 When it comes to patients with chronic mental health conditions, such as depression or anxiety, it's always better to have regular monitoring and real-time feedback. DTx renders the ability to track symptoms over time, providing clinicians with valuable insights. This data-driven decision-making ultimately enhances the effectiveness of interventions. 

Integration with traditional care 

Digital therapeutics can also be integrated with traditional care to provide a comprehensive approach to mental health treatment. By combining digital tools with face-to-face therapy, patients can receive more support and access to care when they need it. 

In conclusion, DTx is emerging as an effective answer to address the prevalent gaps in modern-day mental healthcare. In a survey,  31 per cent of respondents, including healthcare professionals, industry experts, and patients, have chosen it as a top mental healthcare option. With the deepening of its roots, we can expect a healthier and happier tomorrow. 

 

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An estimated two per cent of the global population are immunocompromised, meaning they have weakened immune systems that leave them at heightened risk of infection from bacteria and viruses, according to a report by Astrazeneca on immunocompromised patients. 

The Forgotten Millions: “Mapping Immunocompromised Patients in the Middle East and North Africa” report highlights the needs of this high-risk population and argues that protecting this group is critical. It further showcases the scale and experience of immunocompromised patients in the Middle East and North Africa (MENA) and recommends measures to better protect high-risk patients in the future. 

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In an e-mail interview, co-author of the study Professor Humaid Al-Shamsi, President of the Emirates Oncology Society and Director of Oncology Services at Burjeel Holding, said that there is a lack of comprehensive data and understanding on immunocompromised individuals in the Middle East and North Africa, leaving millions of people across the region vulnerable and disrupting efforts to end the pandemic.  

“The reality of not prioritising people who are at high-risk is alarming. For this reason, public health officials and policymakers are urged to be more concerned about those at risk,” said Prof. Al-Shamsi. 

Related: Harness the power of cancer immunotherapy 

He added that a variety of conditions can weaken the immune system, notably cancer, which is highly prevalent and one of the leading causes of death in the MENA region. An estimated 1,027,939 people are living with cancer at any given time. Others include diabetes, which affects more than 70 million people (18.1 per cent) and chronic kidney disease, which is directly related to diabetes, with rates ranging from 5.2 per cent to 10.6 per cent.  

“Urgent action is needed from all stakeholders to increase understanding of the scale and needs of medically vulnerable people, to protect and support them now and into the future,” he said. According to Prof. Al-Shamsi, cancer and diabetes represent up to one-third of the current overall disease burden in the MENA region.  

“Between patients with cancer, chronic kidney disease (CKD), diabetes and other conditions that require prolonged administration of steroids and HIV/AIDs, the impact is felt across tens of millions of people across the region who are immunocompromised as a result,” he said. 

He also said that secondary immunodeficiency (SID) – by far the most common type – occurs when factors outside the immune system suppress its normal function, such as chronic conditions including, for example, cancer and cancer treatments. 

“Research studies specific to this region is critical as there is currently a lack of comprehensive data and understanding on immunocompromised individuals in the MENA region, leaving millions of people across the region vulnerable and disrupting efforts to end the pandemic,” added the professor. 

Dr Al-Shamsi said that in partnership with policy makers in the region, there was a need to accelerate the collection of centralised data on high-risk groups, including the creation of national registries, to better map the scale and spread of vulnerable population, prioritising those at highest risk e.g., cancer patients and solid organ transplantees. 

“We also recommend prioritising interventions to protect high-risk patients from COVID-19 including public health measures, vaccines and therapies that are specifically researched and developed, and working with health care providers to ensure these options are well-communicated to patients,” he said adding that collaboration with patient groups and civil society organisations are important to ensure that immunocompromised voices are included in decisions that impact them. 

The report has been co-authored by Dr. Viraj Rajadhyaksha, Area Medical Director, Middle East and Africa, AstraZeneca and Dr. Emad Shash, Medical Director of the Breast Cancer Comprehensive Center of the Egypt National Cancer Institute, Cairo University. 

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