- Lormalzi (donanemab) launched in India as a disease-modifying Alzheimer's therapy targeting amyloid plaques
- The treatment suits patients with mild cognitive impairment or mild dementia with confirmed amyloid pathology
- Therapy not recommended for advanced dementia, brain bleeding risk, or severe vascular conditions
India's Alzheimer's treatment landscape has entered a new phase with the launch of Lormalzi (donanemab), a disease-modifying therapy designed to target amyloid plaques in the brain. Unlike conventional Alzheimer's medications that mainly provide symptomatic relief, the new therapy aims to slow progression of the disease itself in carefully selected patients.
Approved for patients with early symptomatic Alzheimer's disease, Lormalzi is intended for individuals with mild cognitive impairment (MCI) due to Alzheimer's disease or those in the mild dementia stage with confirmed amyloid pathology. Experts say the treatment works best when introduced early, before significant brain damage occurs.
However, neurologists caution that the therapy is not suitable for everyone. Factors such as advanced dementia, brain bleeding risk, frailty, MRI abnormalities and certain underlying vascular conditions may limit eligibility.
"The biggest potential benefit is slowing progression of cognitive decline and preserving functional independence for a longer duration in appropriately selected patients," said Dr. Raghav Kapoor, Consultant Neurologist at Fortis Escorts Heart Institute, Okhla.
As India prepares for a sharp rise in dementia cases over the next decade, doctors say understanding who can safely benefit from therapies like donanemab will become increasingly important.
What Is Lormalzi (Donanemab)?
Lormalzi is the Indian brand name for donanemab, a monoclonal antibody therapy developed to target amyloid plaques, abnormal protein accumulations widely associated with Alzheimer's disease progression.
According to the US Food and Drug Administration (FDA), amyloid plaques are considered one of the key pathological hallmarks of Alzheimer's disease. The drug works by binding to amyloid deposits in the brain and helping the body clear them over time.
"The launch of donanemab in India represents a significant step forward in the treatment landscape of Alzheimer's disease," Dr. Kapoor said. "Until now, most available therapies have largely focused on symptomatic relief, offering modest improvement in memory or behavioural symptoms without altering the underlying disease process." He added that donanemab is clinically significant because it is designed as a disease-modifying therapy rather than simply symptom control.
Who Can Take Lormalzi?
According to neurologists, the treatment is intended specifically for:
- patients with mild cognitive impairment (MCI) due to Alzheimer's disease,
- or individuals in the mild dementia stage,
- with confirmed amyloid positivity through appropriate testing.
Doctors emphasise that the therapy is not meant for general memory complaints associated with normal ageing. "It is not a preventive therapy for healthy individuals with age-related forgetfulness," Dr. Kapoor clarified.
Patients typically require specialised neurological evaluation before starting treatment. This may include:
- cognitive assessment,
- MRI scans,
- and biomarker testing such as amyloid PET scans or cerebrospinal fluid (CSF) analysis where available.
Experts say early diagnosis is critical because the therapy appears most effective before extensive neurodegeneration develops.
Who Should Avoid The Therapy?
Neurologists caution that donanemab may not be suitable for several categories of patients. "Patients with advanced Alzheimer's disease are unlikely to derive meaningful benefit," Dr. Kapoor said.
Doctors also recommend caution in individuals with:
- prior brain bleeds,
- multiple cerebral microhemorrhages on MRI,
- uncontrolled hypertension,
- severe vascular disease,
- or those taking strong blood-thinning medications.
This is because the drug carries a risk of ARIA, amyloid-related imaging abnormalities.
According to the FDA, ARIA may involve:
- brain swelling (ARIA-E),
- or small areas of bleeding in the brain (ARIA-H).
"Regular MRI monitoring is therefore essential during treatment," Dr. Kapoor explained. Patients with severe frailty, major co-existing illnesses or unclear diagnosis also require careful assessment before starting therapy.
Why MRI Monitoring Is Important
Neurologists say MRI scans are a central part of safe treatment monitoring.
ARIA may occur without symptoms initially, but some patients can experience:
- headaches,
- confusion,
- dizziness,
- nausea,
- seizures,
- or visual changes.
Because of these risks, doctors recommend scheduled MRI scans before and during therapy. Experts note that treatment decisions must balance potential cognitive benefits against safety risks in each patient individually.
Why The Launch Matters For India
India is expected to see a major rise in dementia burden in the coming decades due to increasing life expectancy and population ageing. "Current estimates suggest that nearly 8.8 million Indians are living with dementia, with Alzheimer's disease accounting for the majority of cases," Dr. Kapoor said. "That number may double by 2036."
According to the World Health Organization (WHO), dementia currently affects more than 55 million people globally, with Alzheimer's disease accounting for approximately 60-70% of cases.
Experts say India faces additional challenges including:
- delayed diagnosis,
- limited awareness,
- caregiver burden,
- and uneven access to specialised neurological care.
Dr. Kapoor said the arrival of disease-modifying therapies may encourage earlier diagnosis and more biomarker-based neurological assessment in India.
Is Donanemab A Cure?
Doctors stress that Lormalzi is not a cure for Alzheimer's disease. The therapy does not reverse existing brain damage or restore lost memory completely. Instead, its primary goal is to slow progression and help preserve independence for longer. "The fact that it is administered once monthly and over a finite duration of around 18 months also makes it clinically interesting compared to lifelong symptomatic medications," Dr. Kapoor noted.
Experts add that lifestyle measures, caregiver support, cognitive stimulation and management of cardiovascular risk factors remain essential components of Alzheimer's care.
The launch of Lormalzi in India marks a significant shift toward more targeted Alzheimer's treatment focused on slowing disease progression rather than only managing symptoms. However, neurologists emphasise that the therapy is intended for carefully selected patients in the earliest symptomatic stages of Alzheimer's disease.
While the treatment offers hope for preserving cognitive function and independence longer, doctors caution that risks such as brain swelling, bleeding abnormalities and the need for ongoing MRI monitoring make thorough evaluation essential before starting therapy.
As India's dementia burden continues to grow, experts say early diagnosis, biomarker testing and specialised neurological care will play an increasingly important role in determining who may truly benefit from this new generation of Alzheimer's therapies.
Disclaimer: This content including advice provides generic information only. It is in no way a substitute for a qualified medical opinion. Always consult a specialist or your own doctor for more information. NDTV does not claim responsibility for this information.
