From the Guidelines
Lecanemab (Leqembi) is the most appropriate monoclonal antibody treatment for mild Alzheimer's disease, administered as an intravenous infusion of 10 mg/kg every two weeks. This recommendation is based on the most recent evidence from 1, which highlights the FDA's traditional approval of lecanemab and its reimbursement by the CMS. Key points to consider when prescribing lecanemab include:
- The need for biomarker confirmation of amyloid pathology before initiation, as emphasized in 1 and 1
- Regular monitoring with MRI scans for potential side effects such as ARIA, as noted in 1
- The importance of early intervention, as these medications may slow cognitive decline but do not reverse existing damage, as discussed in 1 and 1
- Common side effects, including headache, dizziness, and infusion-related reactions, which may require temporary treatment interruption, as mentioned in 1 and 1 It is essential to prioritize the use of lecanemab over other options, given its recent approval and reimbursement status, as well as its potential to slow cognitive decline in patients with mild Alzheimer's disease.
From the Research
Monoclonal Antibody Treatment for Mild Alzheimer's Disease
- Aducanumab is a fully human monoclonal IgG1 antibody that selectively binds aggregated forms of amyloid β, inhibits its template activity, and promotes clearance of Aβ deposits 2.
- It has been approved by the US Food and Drug Administration for the treatment of Alzheimer's disease (AD) 3, 4.
- Aducanumab is delivered by monthly intravenous infusions and is titrated to a dose of 10 mg/kg over a 6-month period 3.
- The treatment is recommended for patients with early AD (mild cognitive impairment due to AD and mild AD dementia) who have confirmed brain amyloid using amyloid positron tomography 3, 5.
Safety and Efficacy
- Aducanumab can substantially increase the incidence of amyloid-related imaging abnormalities (ARIA) with brain effusion or hemorrhage 3, 6.
- The most common adverse event associated with aducanumab is ARIA-edema (ARIA-E), which occurs in approximately 35% of patients 6.
- Common associated symptoms with ARIA-E include headache, confusion, dizziness, and nausea 6.
- The incidence of ARIA-E is highest in aducanumab-treated participants who are apolipoprotein E ε4 allele carriers 6.
Recommendations for Use
- The Expert Panel recommends that use of aducanumab be restricted to patients with early AD (mild cognitive impairment due to AD and mild AD dementia) in which efficacy and safety have been studied 3, 5.
- Clinicians should perform APOE genotyping to better inform patient care decisions and discussions regarding risk 5.
- MRI scans should be performed prior to initiating therapy, during the titration of the drug, and at any time the patient has symptoms suggestive of ARIA 3, 5.