Zunveyl new med on the horizon

allit

I came across some info about this medication today. It just received FDA approval in July 2024 and is predicted to be on the market in early 2025. I'm very curious about it because my wife has been taking rivastigmine and has been having a horrible time with the nausea side effect.

https://alzheimersnewstoday.com/news/fda-approves-zunveyl-alzheimers-therapy-better-tolerability/

I also read this study that was posted in another thread which led me to the info about Zunveyl. There are a few points about galantamine in the study to suggest that there could be better outcomes than with donepezil or rivastigmine.

https://www.neurology.org/doi/10.1212/WNL.0000000000011832

M1

Allit it's a delayed release form of galantamine, a cholinesterase inhibitor that has been around for a long time (brand name Razadyne). It supposedly has less GI side effects. I'm a skeptic about this class of drug though (same as Aricept/namenda/exelon) in that it does not slow progression of the underlying disease. So I wouldn't hold out big hopes. A lot of times moves like this to release a delayed release formulation etc. are a move by the drug companies to be able to charge exorbitant prices for another seventeen years when their patent is running out on the older formulation.

allit

https://alzconnected.org/discussion/comment/222668#Comment_222668

from what I understand it’s a prodrug of galantamine. the prodrug isn’t converted into galantamine until it bypasses the digestive system which hopefully results in less GI side effects. the neurology paper I linked in the post specifically mentions that their data shows that galantamine decreases the risk of severe dementia. that sounds good to me if it all pans out. less side effects = stay on med longer = decrease risk of severe dementia = maybe stay in the home longer and delay high level care

Lucy C

There are probably a lot of people who will try it. I'm not willing to say there are no benefits, but I will say that an overall benefit of 1 point's difference in cognitive decline over 5 years (which is what two-tenths of a point per year works out to) is a bit of a squashy statistic. For instance, if a patient would have dropped five points in five years, but they only dropped four points—how much difference does that make, practically speaking? To their credit, the authors do repeat that the benefits are "modest."

I suppose you could make a case for possibly staying at home longer. The authors certainly do claim that it gives patients longer lives. But given the fact that this is a brutal terminal illness, many families would rather not extend the process beyond its necessary (and much too long) course. Others would do anything to buy more time, and it's probably these folks who will be most interested in the new release.

allit

https://alzconnected.org/discussion/comment/222757#Comment_222757

Good point about extending life considering how “brutal” the late stages of this can be. Thanks for giving me something to think about.

I remember when we had our appointment with the young neurology fellow when he gave us the official diagnosis of MCI with Alzheimer’s pathology. He was very optimistic that with the current research happening that AD could end up being a condition that a patient lives with and doesn’t die from. And since we are so early in our diagnosis, I guess we’re still in that stage where we can’t really comprehend how hard it will be as things progress. We’re just thinking of any way we can hold on to what we have. Hoping a major breakthrough will come along.

Lucy C

https://alzconnected.org/discussion/comment/222823#Comment_222823

I don't think there's a wrong way to feel about all this, honestly. This disease brings up the messiest, most complicated set of emotions that almost anything ever could. I can find myself dealing with a different stage of grief every five minutes, and go through all of them a dozen times before a day ends—and still find things to laugh about in the middle. And sometimes I just want to get off the roller coaster and not deal with any of it.

And then I take a tighter grip on eternity and remember that, yes, we are promised a new heaven and a new earth, and no more death or pain, forever.

allit

Thank you for the kind reply.

I do agree, and have thought about it often, that I’d like to see more relevant end points for the PWD and for caregivers (in our support group we say care partners). Even if it’s a secondary endpoint. Like you mentioned, what good is a longer life if it’s a life of suffering for the PWD and the care partners? Is it a life of fulfillment with meaning? Is it an intervention that will ease suffering?

Also, I’d like to see better tools for assessing the intervention. I know many of the tools to assess cognition have been validated and used often. But I have a hard time interpreting in a meaningful way anything that involves so much subjectivity. Give me something concrete.