2023 brought more COVID subvariants, and also more new drugs in the battle against Alzheimer’s. The Food & Drug Administration approved in early January an Alzheimer’s drug, Leqembi.

By Al Norman

As 2023 entered its first month, the media began spreading stories about the new Covid “subvariant,” XBB.1.5, warning of a potential surge in COVID-19 cases as it sweeps across the Northeast.

This latest omicron strain was described as “the most transmissible subvariant that has been detected yet,” and more adept at getting around the protection offered by vaccines and from prior covid infections. Where I live in the Northeast, one report estimated that XBB.1.5 was responsible for almost three-quarters of new infections. The CDC said XBB.1.5 had become the most prevalent subvariant in America, causing 40.5 percent of cases in the country, but other variants, like BQ.1.1 are causing more cases outside of the East Coast.

The World Health Organization says XBB.1.5 is particularly good at sticking onto a cell and reproducing easily. People who haven’t gotten COVID-19, or been vaccinated, probably have “very little protection against infection” by XBB.1.5. A White House COVID spokesperson told The Hill: “The good news is that the severity of the illness is not worse than from other strains.” XBB.1.5, which has been found in 29 countries, has genetic data from two earlier viral strains.

The longer these viruses circulate, the more combinations are created. The White House said booster vaccines are still the “best protection” against severe illness. Vaccines help block the virus from attaching to cells, but new strains like XBB.1.5 are harder to detect, making it harder for antibodies or immune responses to stop the infection. Oral antiviral pills, like Paxlovid, are still useful if a person gets sick, because such pills attack the virus’ attempts to reproduce itself in the body, rather than by boosting antibodies.

2023 brought more COVID subvariants, and also more new drugs in the battle against Alzheimer’s. The Food & Drug Administration approved in early January an Alzheimer’s drug, Leqembi, that helps people with mild cognitive impairment due to Alzheimer’s, or early stages of the illness. This drug was brought forward by the same two drug partners, Biogen and Eisai, that unveiled Aduhelm, a controversial Alzheimer’s drug I wrote about in 2021 that attracted widespread criticism and concern.

This new medication was approved by the FDA — as was Aduhelm  — under “accelerated pathway” rules, which allows “early approval” for a drug that promises to “fill an unmet medical need,” but requires the company to do additional clinical trials. The drug manufacturers said Leqembi slowed cognitive decline in people who received it by 27 percent after an 18-month trial. People who took the drug still worsened, but not as rapidly as the placebo group. Leqembi slowed the early-stage patients from getting worse by about five months.

The drug removes beta-amyloid clumps in the brain. Experts cautioned, however, that the benefits are small. Equally problematic is the cost: around $25,000 a year. Adulhelm in 2021 was more expensive, and even though Biogen lowered the price after release, the public backlash against the exorbitant cost darkened the drug’s future. The Centers for Medicare & Medicaid Services (CMS) limits coverage of drugs which focus on amyloid in the brain, which will limit sales of this new drug. Several patients died from brain swelling and brain bleeding after taking Leqembi. In clinical trials, brain swelling was more than 7 times more prevalent in patients who took the new drug, versus patients who received a placebo.

The co-founder of the Alzheimer’s Drug Discovery Foundation described Leqembi as “encouraging news,” but added: “Alzheimer’s therapies will only be beneficial to patients if the right drug is given to the right patient at the right time based on their unique disease pathology…We need — and are on the way to having — multiple drugs we can combine to personalize treatments to match each patient’s Alzheimer’s pathology, which will have a much greater impact on slowing the disease.”

     The high price tag of this new medication is likely to generate major controversy throughout the rest of 2023.

Al Norman worked in the field of elderly home care in Massachusetts for more than three decades. He has been writing columns for the 50+Life almost for as many years.