Quote · The Peter Attia Drive
#399 ‒ The evolution of Alzheimer's disease and dementia care: how early detection, personalized treatment, new therapies, and a multimodal approach are changing the landscape | Gayatri Devi, M.D.
Where this was said
Aducanumab controversy and why she prescribed it
At 1:00:59 · chapter starts 1:00:00
Aducanumab's approval in July 2021 was one of the most controversial FDA decisions in memory: the agency overruled its own advisory board, which found the amyloid-lowering effects did not translate reliably into clinical benefit. Gayatri Devi was nonetheless among the first physicians to prescribe it, applying her personal rule: would she want this drug if she had Alzheimer's herself [1] — Gayatri Devi "The other thing, Peter, I always ask myself anytime a new drug comes out is, would I want this drug? If I had Alzheimer's now, knowing ever…" 1:00:59 ? Her answer was yes — reasoning that even a small clinical benefit combined with disease-modifying amyloid clearance was worth trying, especially if the ARIA risk could be mitigated with slow titration. The drug was ultimately pulled from the market not because of safety failures but because the post-approval monitoring obligations became financially unviable for Biogen, leaving only lecanemab and donanemab in the field.
Lecanemab and donanemab each cost approximately $26,000 per year for the drug alone, with additional administration fees ranging from $400 to $10,000 per infusion.
Anti-amyloid antibodies clear amyloid not just from brain substrate but also from the walls of small brain arteries. This disrupts vascular integrity, causing fluid leakage (ARIA-E, edema) and then actual blood extravasation (ARIA-H, hemorrhage). In severe cases with blood thinners or large vessel disruption, it can be fatal.
