This week's decision by the US Food and Drug Administration to approve the use of aducanumab or Aduhelm to treat patients with Alzheimer's disease may be an inflection point in the race to find a cure for dementia.
Aduhelm is reported to tackle the progressive degenerative disease of the brain by reducing deposits of amyloid plaque that impair memory once they begin to build up. Other previously licensed inhibitor drugs only seek to slow down cognitive decline rather than address the disease head on, which is why there is so much interest in this new treatment.
Biogen, the company developing the drug, says the treatment will answer a significant unmet need for those diagnosed with the disease, although critics argue its performance was mixed during late-stage trials.
If it lives up to its billing, however, the drug will bring hope to an arena where traditionally there has been next to none.
The FDA’s decision, however, also represents an apparent U-turn from the body’s previous pronouncement on the progress of the drug in November 2020.
Last year, the FDA's Peripheral and Central Nervous System Drugs Advisory Committee voted on the question of whether there was strong evidence to support the effectiveness of aducanumab in treating Alzheimer's. Eight members of the committee voted no, two were uncertain and one member said yes.
This may explain why this week’s statement on the approval acknowledged the question marks around the drug’s effectiveness.
Hope and possibility is always better than despair and inaction
In a memo released on Monday, Dr Patrizia Cavazzoni, director of the FDA Centre for Drug Evaluation and Research, concluded that the data provided for approval was "highly complex and left residual uncertainties regarding clinical benefit" and said it was unsurprised that there was so much attention on the approval.
Dr Cavazzoni went on to say that the FDA had determined that the drug would be given its accelerated approval path, which gives access to “potentially valuable therapies for patients with serious diseases where there is an unmet need and where there is an expectation of clinical benefit despite some residual uncertainty.”
Whatever way you look at it, this is a volte-face from the apparent hard-no delivered in November. Ultimately, the FDA decided the potential benefits exceed the risks.
Some of the reasons why this decision has been applauded by carers and families of those diagnosed with dementia is grounded in the belief that trying some form of treatment, even if it proves unsuccessful, is preferable to doing nothing. Hope and possibility is always better than despair and inaction.
In that respect, the accelerated approval of Aduhelm may yet be seen as a moon shot, although the real destination point must be to establish what triggers the amyloid plaques and to see if they can be identified and reversed at an earlier stage.
The unstated gamble in the Aduhelm accelerated approval is that it will turbocharge that space for dementia research or, indeed, Biogen’s drug may turn out to fully answer those unmet needs by overcoming those residual question marks. The lost cause of dementia may just have found a patron.
All this hope comes with a heavy price tag.
Infusions of Aduhelm will cost around $4,000 a month or $56,000 a year (Dh205,500) and with no certainty that the drug will work or that health insurers or healthcare providers would support the treatment. Patients would also have to pay for regular brain scans, which are rarely cheap.
No wonder it has been described as a blockbuster drug for Biogen, but it may yet break the banks of hopeful families if it is widely adopted. Indeed, it is of a similar price to residential care costs for someone diagnosed with dementia, so while there may be considerable emotional comfort in pursuing treatment there is little economic benefit when weighed against nursing home charges.
Governments too have borne enormous financial costs to keep societies at home or on furlough during the coronavirus pandemic, but will they be willing to pay such bills to meet dementia prevention, cure and treatment needs for a significant portion of their populations? History tells us, probably not.
By contrast, Aricept, which is one of the inhibitor drugs that seeks to slow not stop progression of the disease, costs around $350 a month or $4,200 a year (Dh15,500), but only helps in the early stages of Alzheimer’s and in some cases has not been effective at all. The window of usefulness can, and often does, snap shut very quickly and, in any case, the side effects can make it hard to use for very long.
This is not to present a field of bad choices, because Aduhelm’s accelerated approval is undoubtedly significant and, equally, inhibitor drugs, such as Aricept, have proven valuable by delaying decline in many people.
Last month, Alzheimer’s Disease International published a report on global progress to meet World Health Organisation targets to develop national dementia plans by 2025. ADI estimates that 50 million people live with dementia today. That figure could rise to more than 150 million people by 2050. A new case of dementia is diagnosed every three seconds of every day, somewhere in the world. The report concludes that we are underprepared for an advancing dementia crisis, which makes Aduhelm’s approval all the more timely.
The ADI says the pandemic has given us insight into what happens when the world is unprepared for a health crisis. More than 3.7m people have died since the coronavirus crisis began. Estimates also suggest a significant portion of those deaths were among people diagnosed with dementia. The emotional heartache and societal complications delivered by the pandemic in general are almost immeasurable.
The next few years will tell us whether Aduhelm is a genuine turning point or merely another marker on the long and never-ending road to beat Alzheimer’s. Let’s hope it is a watershed. Don’t be surprised if it is not.
Nick March is an assistant editor-in-chief at The National
More from The National
Mohammed bin Zayed Majlis
COMPANY PROFILE
Company name: Blah
Started: 2018
Founder: Aliyah Al Abbar and Hend Al Marri
Based: Dubai
Industry: Technology and talent management
Initial investment: Dh20,000
Investors: Self-funded
Total customers: 40
Key figures in the life of the fort
Sheikh Dhiyab bin Isa (ruled 1761-1793) Built Qasr Al Hosn as a watchtower to guard over the only freshwater well on Abu Dhabi island.
Sheikh Shakhbut bin Dhiyab (ruled 1793-1816) Expanded the tower into a small fort and transferred his ruling place of residence from Liwa Oasis to the fort on the island.
Sheikh Tahnoon bin Shakhbut (ruled 1818-1833) Expanded Qasr Al Hosn further as Abu Dhabi grew from a small village of palm huts to a town of more than 5,000 inhabitants.
Sheikh Khalifa bin Shakhbut (ruled 1833-1845) Repaired and fortified the fort.
Sheikh Saeed bin Tahnoon (ruled 1845-1855) Turned Qasr Al Hosn into a strong two-storied structure.
Sheikh Zayed bin Khalifa (ruled 1855-1909) Expanded Qasr Al Hosn further to reflect the emirate's increasing prominence.
Sheikh Shakhbut bin Sultan (ruled 1928-1966) Renovated and enlarged Qasr Al Hosn, adding a decorative arch and two new villas.
Sheikh Zayed bin Sultan (ruled 1966-2004) Moved the royal residence to Al Manhal palace and kept his diwan at Qasr Al Hosn.
Sources: Jayanti Maitra, www.adach.ae
The%20specs
%3Cp%3E%3Cstrong%3EEngine%3A%20%3C%2Fstrong%3E3.0%20twin-turbo%20inline%20six-cylinder%0D%3Cbr%3E%3Cstrong%3ETransmission%3A%20%3C%2Fstrong%3Eeight-speed%0D%3Cbr%3E%3Cstrong%3EPower%3A%20%3C%2Fstrong%3E503hp%0D%3Cbr%3E%3Cstrong%3ETorque%3A%20%3C%2Fstrong%3E600Nm%0D%3Cbr%3E%3Cstrong%3EPrice%3A%20%3C%2Fstrong%3Efrom%20Dh450%2C000%0D%3Cbr%3E%3Cstrong%3EOn%20sale%3A%20%3C%2Fstrong%3Enow%3C%2Fp%3E%0A
The%20specs
%3Cp%3E%3Cstrong%3EEngine%3A%3C%2Fstrong%3E%201.8-litre%204-cyl%20turbo%0D%3Cbr%3E%3Cstrong%3EPower%3A%20%3C%2Fstrong%3E190hp%20at%205%2C200rpm%0D%3Cbr%3E%3Cstrong%3ETorque%3A%3C%2Fstrong%3E%20320Nm%20from%201%2C800-5%2C000rpm%0D%3Cbr%3E%3Cstrong%3ETransmission%3A%20%3C%2Fstrong%3ESeven-speed%20dual-clutch%20auto%0D%3Cbr%3E%3Cstrong%3EFuel%20consumption%3A%3C%2Fstrong%3E%206.7L%2F100km%0D%3Cbr%3E%3Cstrong%3EPrice%3A%3C%2Fstrong%3E%20From%20Dh111%2C195%0D%3Cbr%3E%3Cstrong%3EOn%20sale%3A%20%3C%2Fstrong%3ENow%3C%2Fp%3E%0A
World Cricket League Division 2
In Windhoek, Namibia - Top two teams qualify for the World Cup Qualifier in Zimbabwe, which starts on March 4.
UAE fixtures
Thursday, February 8 v Kenya; Friday, February 9 v Canada; Sunday, February 11 v Nepal; Monday, February 12 v Oman; Wednesday, February 14 v Namibia; Thursday, February 15 final
Ten tax points to be aware of in 2026
1. Domestic VAT refund amendments: request your refund within five years
If a business does not apply for the refund on time, they lose their credit.
2. E-invoicing in the UAE
Businesses should continue preparing for the implementation of e-invoicing in the UAE, with 2026 a preparation and transition period ahead of phased mandatory adoption.
3. More tax audits
Tax authorities are increasingly using data already available across multiple filings to identify audit risks.
4. More beneficial VAT and excise tax penalty regime
Tax disputes are expected to become more frequent and more structured, with clearer administrative objection and appeal processes. The UAE has adopted a new penalty regime for VAT and excise disputes, which now mirrors the penalty regime for corporate tax.
5. Greater emphasis on statutory audit
There is a greater need for the accuracy of financial statements. The International Financial Reporting Standards standards need to be strictly adhered to and, as a result, the quality of the audits will need to increase.
6. Further transfer pricing enforcement
Transfer pricing enforcement, which refers to the practice of establishing prices for internal transactions between related entities, is expected to broaden in scope. The UAE will shortly open the possibility to negotiate advance pricing agreements, or essentially rulings for transfer pricing purposes.
7. Limited time periods for audits
Recent amendments also introduce a default five-year limitation period for tax audits and assessments, subject to specific statutory exceptions. While the standard audit and assessment period is five years, this may be extended to up to 15 years in cases involving fraud or tax evasion.
8. Pillar 2 implementation
Many multinational groups will begin to feel the practical effect of the Domestic Minimum Top-Up Tax (DMTT), the UAE's implementation of the OECD’s global minimum tax under Pillar 2. While the rules apply for financial years starting on or after January 1, 2025, it is 2026 that marks the transition to an operational phase.
9. Reduced compliance obligations for imported goods and services
Businesses that apply the reverse-charge mechanism for VAT purposes in the UAE may benefit from reduced compliance obligations.
10. Substance and CbC reporting focus
Tax authorities are expected to continue strengthening the enforcement of economic substance and Country-by-Country (CbC) reporting frameworks. In the UAE, these regimes are increasingly being used as risk-assessment tools, providing tax authorities with a comprehensive view of multinational groups’ global footprints and enabling them to assess whether profits are aligned with real economic activity.
Contributed by Thomas Vanhee and Hend Rashwan, Aurifer
Tamkeen's offering
- Option 1: 70% in year 1, 50% in year 2, 30% in year 3
- Option 2: 50% across three years
- Option 3: 30% across five years
The specs: 2018 Chevrolet Trailblazer
Price, base / as tested Dh99,000 / Dh132,000
Engine 3.6L V6
Transmission: Six-speed automatic
Power 275hp @ 6,000rpm
Torque 350Nm @ 3,700rpm
Fuel economy combined 12.2L / 100km
The specs
Engine: 2.0-litre 4cyl turbo
Power: 261hp at 5,500rpm
Torque: 405Nm at 1,750-3,500rpm
Transmission: 9-speed auto
Fuel consumption: 6.9L/100km
On sale: Now
Price: From Dh117,059
Ipaf in numbers
Established: 2008
Prize money: $50,000 (Dh183,650) for winners and $10,000 for those on the shortlist.
Winning novels: 13
Shortlisted novels: 66
Longlisted novels: 111
Total number of novels submitted: 1,780
Novels translated internationally: 66
Sholto Byrnes on Myanmar politics
The specs
- Engine: 3.9-litre twin-turbo V8
- Power: 640hp
- Torque: 760nm
- On sale: 2026
- Price: Not announced yet
Sheer grandeur
The Owo building is 14 storeys high, seven of which are below ground, with the 30,000 square feet of amenities located subterranean, including a 16-seat private cinema, seven lounges, a gym, games room, treatment suites and bicycle storage.
A clear distinction between the residences and the Raffles hotel with the amenities operated separately.
PROFILE OF HALAN
Started: November 2017
Founders: Mounir Nakhla, Ahmed Mohsen and Mohamed Aboulnaga
Based: Cairo, Egypt
Sector: transport and logistics
Size: 150 employees
Investment: approximately $8 million
Investors include: Singapore’s Battery Road Digital Holdings, Egypt’s Algebra Ventures, Uber co-founder and former CTO Oscar Salazar
MOTHER%20OF%20STRANGERS
%3Cp%3EAuthor%3A%20Suad%20Amiry%3Cbr%3EPublisher%3A%20Pantheon%3C%2Fp%3E%0A%3Cp%3EPages%3A%20304%3Cbr%3EAvailable%3A%20Now%3C%2Fp%3E%0A
Company%20profile
%3Cp%3E%3Cstrong%3EName%3A%3C%2Fstrong%3E%20JustClean%3Cbr%3E%3Cbr%3E%3Cstrong%3EBased%3A%20%3C%2Fstrong%3EDubai%20with%20offices%20in%20other%20GCC%20countries%3Cbr%3E%3Cbr%3E%3Cstrong%3ELaunch%20year%3A%3C%2Fstrong%3E%202016%3Cbr%3E%3Cbr%3E%3Cstrong%3ENumber%20of%20employees%3A%3C%2Fstrong%3E%20160%2B%20with%2021%20nationalities%20in%20eight%20cities%3Cbr%3E%3Cstrong%3E%3Cbr%3ESector%3A%3C%2Fstrong%3E%20online%20laundry%20and%20cleaning%20services%3Cbr%3E%3Cbr%3E%3Cstrong%3EFunding%3A%20%3C%2Fstrong%3E%2430m%20from%20Kuwait-based%20Faith%20Capital%20Holding%20and%20Gulf%20Investment%20Corporation%3C%2Fp%3E%0A
MATCH INFO
Brescia 1 (Skrinia og, 76)
Inter Milan 2 (Martinez 33, Lukaku 63)
'Top Gun: Maverick'
Rating: 4/5
Directed by: Joseph Kosinski
Starring: Tom Cruise, Val Kilmer, Jennifer Connelly, Jon Hamm, Miles Teller, Glen Powell, Ed Harris
How to protect yourself when air quality drops
Install an air filter in your home.
Close your windows and turn on the AC.
Shower or bath after being outside.
Wear a face mask.
Stay indoors when conditions are particularly poor.
If driving, turn your engine off when stationary.
THE LIGHT
Director: Tom Tykwer
Starring: Tala Al Deen, Nicolette Krebitz, Lars Eidinger
Rating: 3/5
Your rights as an employee
The government has taken an increasingly tough line against companies that fail to pay employees on time. Three years ago, the Cabinet passed a decree allowing the government to halt the granting of work permits to companies with wage backlogs.
The new measures passed by the Cabinet in 2016 were an update to the Wage Protection System, which is in place to track whether a company pays its employees on time or not.
If wages are 10 days late, the new measures kick in and the company is alerted it is in breach of labour rules. If wages remain unpaid for a total of 16 days, the authorities can cancel work permits, effectively shutting off operations. Fines of up to Dh5,000 per unpaid employee follow after 60 days.
Despite those measures, late payments remain an issue, particularly in the construction sector. Smaller contractors, such as electrical, plumbing and fit-out businesses, often blame the bigger companies that hire them for wages being late.
The authorities have urged employees to report their companies at the labour ministry or Tawafuq service centres — there are 15 in Abu Dhabi.
Islamophobia definition
A widely accepted definition was made by the All Party Parliamentary Group on British Muslims in 2019: “Islamophobia is rooted in racism and is a type of racism that targets expressions of Muslimness or perceived Muslimness.” It further defines it as “inciting hatred or violence against Muslims”.
Skoda Superb Specs
Engine: 2-litre TSI petrol
Power: 190hp
Torque: 320Nm
Price: From Dh147,000
Available: Now
Ferrari 12Cilindri specs
Engine: naturally aspirated 6.5-liter V12
Power: 819hp
Torque: 678Nm at 7,250rpm
Price: From Dh1,700,000
Available: Now
Why%20all%20the%20lefties%3F
%3Cp%3ESix%20of%20the%20eight%20fast%20bowlers%20used%20in%20the%20ILT20%20match%20between%20Desert%20Vipers%20and%20MI%20Emirates%20were%20left-handed.%20So%2075%20per%20cent%20of%20those%20involved.%0D%3Cbr%3EAnd%20that%20despite%20the%20fact%2010-12%20per%20cent%20of%20the%20world%E2%80%99s%20population%20is%20said%20to%20be%20left-handed.%0D%3Cbr%3EIt%20is%20an%20extension%20of%20a%20trend%20which%20has%20seen%20left-arm%20pacers%20become%20highly%20valued%20%E2%80%93%20and%20over-represented%2C%20relative%20to%20other%20formats%20%E2%80%93%20in%20T20%20cricket.%0D%3Cbr%3EIt%20is%20all%20to%20do%20with%20the%20fact%20most%20batters%20are%20naturally%20attuned%20to%20the%20angles%20created%20by%20right-arm%20bowlers%2C%20given%20that%20is%20generally%20what%20they%20grow%20up%20facing%20more%20of.%0D%3Cbr%3EIn%20their%20book%2C%20%3Cem%3EHitting%20Against%20the%20Spin%3C%2Fem%3E%2C%20cricket%20data%20analysts%20Nathan%20Leamon%20and%20Ben%20Jones%20suggest%20the%20advantage%20for%20a%20left-arm%20pace%20bowler%20in%20T20%20is%20amplified%20because%20of%20the%20obligation%20on%20the%20batter%20to%20attack.%0D%3Cbr%3E%E2%80%9CThe%20more%20attacking%20the%20batsman%2C%20the%20more%20reliant%20they%20are%20on%20anticipation%2C%E2%80%9D%20they%20write.%0D%3Cbr%3E%E2%80%9CThis%20effectively%20increases%20the%20time%20pressure%20on%20the%20batsman%2C%20so%20increases%20the%20reliance%20on%20anticipation%2C%20and%20therefore%20increases%20the%20left-arm%20bowler%E2%80%99s%20advantage.%E2%80%9D%0D%3Cbr%3E%3C%2Fp%3E%0A
Learn more about Qasr Al Hosn
In 2013, The National's History Project went beyond the walls to see what life was like living in Abu Dhabi's fabled fort:
Super heroes
Iron Man
Reduced risk of dementia
Alcohol consumption could be an issue
Hulk
Cardiac disease, stroke and dementia from high heart rate
Spider-Man
Agility reduces risk of falls
Increased risk of obesity and mental health issues
Black Panther
Vegetarian diet reduces obesity
Unknown risks of potion drinking
Black Widow
Childhood traumas increase risk of mental illnesses
Thor
He's a god
HEY%20MERCEDES%2C%20WHAT%20CAN%20YOU%20DO%20FOR%20ME%3F
%3Cp%3EMercedes-Benz's%20MBUX%20digital%20voice%20assistant%2C%20Hey%20Mercedes%2C%20allows%20users%20to%20set%20up%20commands%20for%3A%3C%2Fp%3E%0A%3Cp%3E%E2%80%A2%20Navigation%3C%2Fp%3E%0A%3Cp%3E%E2%80%A2%20Calls%3C%2Fp%3E%0A%3Cp%3E%E2%80%A2%20In-car%20climate%3C%2Fp%3E%0A%3Cp%3E%E2%80%A2%20Ambient%20lighting%3C%2Fp%3E%0A%3Cp%3E%E2%80%A2%20Media%20controls%3C%2Fp%3E%0A%3Cp%3E%E2%80%A2%20Driver%20assistance%3C%2Fp%3E%0A%3Cp%3E%E2%80%A2%20General%20inquiries%20such%20as%20motor%20data%2C%20fuel%20consumption%20and%20next%20service%20schedule%2C%20and%20even%20funny%20questions%3C%2Fp%3E%0A%3Cp%3E%3Cstrong%3EThere's%20also%20a%20hidden%20feature%3A%3C%2Fstrong%3E%20pressing%20and%20holding%20the%20voice%20command%20button%20on%20the%20steering%20wheel%20activates%20the%20voice%20assistant%20on%20a%20connected%20smartphone%20%E2%80%93%20Siri%20on%20Apple's%20iOS%20or%20Google%20Assistant%20on%20Android%20%E2%80%93%20enabling%20a%20user%20to%20command%20the%20car%20even%20without%20Apple%20CarPlay%20or%20Android%20Auto%3C%2Fp%3E%0A
LILO & STITCH
Starring: Sydney Elizebeth Agudong, Maia Kealoha, Chris Sanders
Director: Dean Fleischer Camp
Rating: 4.5/5
Zakat definitions
Zakat: an Arabic word meaning ‘to cleanse’ or ‘purification’.
Nisab: the minimum amount that a Muslim must have before being obliged to pay zakat. Traditionally, the nisab threshold was 87.48 grams of gold, or 612.36 grams of silver. The monetary value of the nisab therefore varies by current prices and currencies.
Zakat Al Mal: the ‘cleansing’ of wealth, as one of the five pillars of Islam; a spiritual duty for all Muslims meeting the ‘nisab’ wealth criteria in a lunar year, to pay 2.5 per cent of their wealth in alms to the deserving and needy.
Zakat Al Fitr: a donation to charity given during Ramadan, before Eid Al Fitr, in the form of food. Every adult Muslim who possesses food in excess of the needs of themselves and their family must pay two qadahs (an old measure just over 2 kilograms) of flour, wheat, barley or rice from each person in a household, as a minimum.
Dhadak 2
Director: Shazia Iqbal
Starring: Siddhant Chaturvedi, Triptii Dimri
Rating: 1/5
The Bio
Favourite place in UAE: Al Rams pearling village
What one book should everyone read: Any book written before electricity was invented. When a writer willingly worked under candlelight, you know he/she had a real passion for their craft
Your favourite type of pearl: All of them. No pearl looks the same and each carries its own unique characteristics, like humans
Best time to swim in the sea: When there is enough light to see beneath the surface