5 Things to Know About Lecanemab

5 Things to Know About Lecanemab

Your doctor may not offer it yet.

Lecanemab (Leqembi) is a new drug that treats cognitive decline due to Alzheimer’s disease. To establish drug eligibility, patients will need to confirm that a certain type of protein called amyloid is present in their brain. Either a positron emission tomography (PET) scan or biomarker testing (through a lumbar puncture or blood tests) are used in research and other non-clinical settings to confirm the presence of this protein. Not all health care systems, doctors, or facilities are equipped to offer these types of tests yet.  Some doctors are also waiting to see if the Centers of Medicare and Medicaid are covering this new treatment so that treatment can be offered to all their patients, instead of only those who can afford the projected $26,500 yearly cost. Lastly, some health care systems and clinicians are waiting for more clinical trial data to be released before offering it in their clinics. 

In a completed clinical trial that lasted 18 months, researchers saw reduction in cognitive impairment in both the treatment group and the placebo group, however the treatment group had a more significant decline. Specifically, the treatment group’s cognitive abilities declined by 1.21 points to a final score of 4.41 on neuropsychological testing, while the placebo group’s declined by 1.66 points to 4.86. In other words, the drug slowed cognitive decline by 27 percent overall. While the trial implications are hopeful, there were some negative reactions to the drug. Of the trial subjects who received the drug, 26.4% had infusion-related reactions and 12.6% experienced brain edema and swelling. 

You may not qualify for drug treatment, but there are other options.

Lecanemab is most helpful for patients who are not yet symptomatic or are in the milder stages of the disease. Some patients may not qualify for the drug due to severity of disease or from other pre-existing chronic medical conditions. For example, researchers are still evaluating the risk and benefit to patients who are on blood thinners. 

For patients who do not qualify for drug treatment, active disease management and lifestyle optimization is key. Sleep, physical exercise, and diet interventions, in particular, have been shown to help mitigate neurodegenerative disease progression. The renowned Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGERS) clinical trial demonstrated that healthy lifestyle changes measurably help to slow or prevent cognitive decline. The initial two-year trial, whose follow-up trials are ongoing, involved 1,260 participants aged 60-77 years with moderate degenerative risk scores. Those who underwent multidomain lifestyle interventions improved their cognitive performance by 25%.

At BrainHealth, we are excited to launch a new type of lifestyle intervention coaching for patients with cognitive risks or who are in the early stages of the disease. Sign up to be part of our early access pilot!

The Neurologist’s wait list might be long.

In 2017, researchers demonstrated that by 2025 there would be significant challenges to accessing dementia neurologists, with some areas of the United States having greater demand than supply of neurologists. Called "Dementia Neurology Deserts," these regions are likely to produce longer than usual wait times to see a neurologist. This delay may impact patients’ access to Lecanemab and other imminent new drugs, allowing disease to worsen in the interim.

As part of the Lecanemab launch, health systems and physician practices around the country are evaluating new and innovative ways to access more patients sooner, however during the early phases of this drug launch, patients may encounter significant wait times. Getting on a waitlist may help qualified patients to gain access sooner.

You will have to get regular MRI scans. 

As part of the monitoring required while taking this new medication, patients will need regular MRI brain scans. Patients with claustrophobia, limited transportation, economic limitations, or other challenges may find this frequent monitoring difficult. Further, patients with pacemakers or other implanted metal medical devices may not be able to get MRI scans, which would disqualify them for treatment.

You will want to track your changes over time.

The benefit of Lecanemab treatment was seen primarily on neuropsychological tests. Researchers are still evaluating how this new treatment will affect patients’ daily activities or living circumstances, such as if there are impacts on ability to drive, live alone, or gain nursing home placement. 

As part of BrainHealth's program, you will be able to connect your wearables, mobile health data, and other medical data and trend your cognitive changes over time.

References:

Lecanemab FDA Press Release, Jan 2022: https://www.fda.gov/news-events/press-announcements/fda-grants-accelerated-approval-alzheimers-disease-treatment

Rao et al.  Dementia Neurology Deserts - What Are They and Where Are They Located in the US? 

Liu, Jodi L., Jakub P. Hlavka, Richard Hillestad, and Soeren Mattke, Assessing the Preparedness of the U.S. Health Care System Infrastructure for an Alzheimer's Treatment. Santa Monica, CA: RAND Corporation, 2017. https://www.rand.org/pubs/research_reports/RR2272.html

Van Dyck et al, Lecanemab in Early Alzheimer’s Disease, NEJM Jan 2023 https://www.nejm.org/doi/10.1056/NEJMoa2212948