NF52 wrote:It seems reasonable to me that seeking to maintain insulin resistance, cardiac health, low oxidative stress, etc. is not inconsistent with recognizing a genetic predisposition to one (not the only) key pathogen seen in AD and looking for therapies to eliminate that toxin from the brain one it is evident. One is not incompatible with the other.
AT CTAD, Dr. Sharon Cohen, a neurologist and Director of the Toronto Memory Program (who noted receiving only institutional research fees, not personal consulting fees) spoke about the planned inclusion of people with common health factors in CLARITY to assess both the benefit and risks of lecanemab based on comorbidities.
Dr. Cohen noted in her talk that 50% of participants had two or more co-morbidities. Given the totals of 898 people on lecanemab, the slide shows that 95.7% had at least one of the following risk factors; of 898 on the placebo, it was 97.5 %. Yet analysis by types of comorbidity of CDR-SB scores favored lecanemab for each of the conditions, with the largest results (52% less decline) in those with heart disease. [I hope to see more detailed analysis by ApoE 4 sub-type by comorbidity at some point.]
Those at risk of progression of both MCI/mild Alzheimer's dementia, who also risk serious illness from obesity, diabetes, high blood pressure and heart disease may regret choices they made earlier in life-and so may have been more than willing to enroll in CLARITY and to continue in the Open-Label Extension, whether they were on placebo or lecanemab in the original phase. They may view that given their prognosis, they cannot let "the perfect to be the enemy of the good." Sadly, these are probably not typical of the people who enrolled in Dr. Bredesen's pilot study, and comparisons between outcomes may be comparing people at two very different levels of pathology and risk.