Q & A on what you should learn about lecanemab

This week the U.S. Meals and Drug Administration authorised the drug lecanemab after analysis confirmed it slowed the development of Alzheimer’s illness in some sufferers with delicate cognitive impairment.

That is undoubtedly a breakthrough for therapy of an irreversible, progressive mind dysfunction affecting greater than 6.5 million Individuals. Whereas the drug was granted so-called accelerated approval in January, full FDA approval means wider protection by Medicare so it could higher attain sufferers.

Named Leqembi, lecanemab’s approval has triggered much less controversy than a associated drug referred to as Aduhelm, or aducanumab, as a result of its scientific trial outcomes are extra definitive.

With assist from Stanford and UC San Francisco specialists, we reply questions concerning the new drug.

Q: What’s lecanemab?

A: It’s a drug that’s designed to take away amyloid beta, a sticky plaque that builds up within the mind in individuals with Alzheimer’s illness, inflicting illness development. It’s the first anti-amyloid therapy to earn full approval by the FDA.

The drug, developed by the Japanese pharmaceutical firm Eisai and offered in partnership with Biogen, is priced round $26,500 yearly per affected person.

Q: Does the drug remedy Alzheimer’s?

A: No. Sufferers continued to expertise decline in cognition and independence. However lecanemab causes a modest discount within the development of the earliest levels of the illness, slowing the speed of cognitive decline by 27% in contrast with a placebo in an 18-month examine of 1,800 sufferers with early Alzheimer’s illness. This translated to a roughly 6-month delay in symptom development, giving sufferers extra significant time with their pals and households.

Q: Who’s eligible for lecanemab?

A: This drug will solely be prescribed for sufferers who’re within the early levels of Alzheimer’s illness with a prognosis of delicate cognitive impairment or delicate dementia.

Sufferers with average or extreme dementia or different diagnoses will not be eligible, as a result of there is no such thing as a security or effectiveness information on its use in individuals with extra superior illness.

It’s not really helpful for sufferers with a historical past of stroke or seizures, bleeding problems or therapy with blood thinners, immune situations or therapy with immunosuppressants, different severe situations reminiscent of most cancers, MRI abnormalities with proof of a tumor or hemorrhage or hypersensitivity to monoclonal antibody therapy.

Q: What is required to get therapy?

A: Earlier than beginning lecanemab, your physician might want to affirm the presence of amyloid in your mind. This requires both an amyloid PET scan or spinal faucet. As a result of sufferers who’ve a particular genetic variation referred to as ApoE4 are additionally at increased danger of unwanted side effects, genetic testing previous to receiving therapy is required.

At Stanford Well being Care, neurologists will think about therapy for sufferers who’re: ages 50 to 90 years, capable of bear frequent MRI scans and have PET scans or cerebrospinal fluid to verify the presence of mind amyloid. Sufferers have to be prepared to bear ApoE4 genotype testing. It’s also really helpful that they’ve have a care accomplice or another person to assist their frequent visits.

Q: How is lecanemab administered?

A: Lecanemab is given intravenously — infused by way of a vein — each two weeks.

Q: The place will therapy be supplied?

A: As a result of neurologists and particular tools are wanted to guage sufferers and administer the drug, its use will likely be restricted to massive educational hospitals and specialty clinics.

Q: What are some potential dangers of lecanemab?

A: The drug is thought to trigger mind swelling or bleeding, referred to as amyloid associated imaging abnormality (ARIA) in about 20% of sufferers. Whereas most sufferers with ARIA present no signs, some might expertise headache, visible modifications, and confusion. The bulk — seven to eight of 10 circumstances — of ARIA resolve inside three to 4 months. Whereas extreme signs and problems happen in fewer than 1 in 100 sufferers with ARIA, a minimum of three individuals have died of great mind bleeds after taking the drug.

The drug may also trigger infusion-related reactions in about 20% of sufferers. Most of those reactions occurred with the primary therapy. These signs might embody modifications in blood stress, modifications in respiration, pores and skin modifications, fevers, and chills. The vast majority of infusion reactions brought on by lecanemab have been simply treatable.

Q: Is lecanemab coated by Medicare or different insurance coverage?

A: To be coated by Medicare, a affected person have to be recognized with delicate cognitive impairment or delicate dementia attributable to Alzheimer’s illness and take part in a registry.

Amyloid PET scans will not be presently coated by insurance coverage. Protection for different required assessments – reminiscent of MRI scans, blood assessments or cerebrospinal fluid evaluation — is just not but sure.

The provision of personal insurance coverage protection is just not but identified.

Q: How does lecanemab differ from aducanumab, or Aduhelm, which gained the FDA’s accelerated approval in June 2021?

A: The 2 medicine act by way of an identical mechanism. However Aduhelm targets a special model of amyloid and could also be much less efficient at eradicating the plaque. Two massive trials of Aduhelm in individuals with early symptomatic Alzheimer’s illness have been discontinued prematurely, and one trial didn’t present a profit in signs. Due to conflicting outcomes on whether or not it slowed cognitive decline, Aduhelm is just not coated by most insurers.

For extra info:

UCSF’s Reminiscence and Ageing Middle: https://memory.ucsf.edu/lecanemab
Stanford Well being Care Middle for Reminiscence Problems: https://stanfordhealthcare.org/campaigns/lecanemab.html