Practical NeurologyNew Clinical Guidance for Treating Alzheimer Disease with Antiamyloid Monoclonal Antibodies Published

Leqembi (lecanemab-irmb) has received FDA approval in July and has demonstrated efficacy in slowing cognitive and functional decline in Alzheimer’s patients.

The journal Neurology has unveiled a comprehensive guide on the utilization of antiamyloid monoclonal antibodies in Alzheimer’s disease management, spotlighting the recent FDA-approved Leqembi and its implications for clinical practice.

Key Points:

• Clinicians must consider several factors before initiating treatment with antiamyloid mAbs like Leqembi, including disease stage, cognitive impairment level, brain amyloidosis, comorbidities, potential drug interactions, and APOE ε4 allele status.
• A collaborative decision-making approach involving clinicians, patients, caregivers, and families is crucial given the complexity of Alzheimer’s and the treatment.
• Leqembi requires IV infusion every 2 weeks, with subsequent MRI monitoring for ARIA and the establishment of emergency pathways and communication with radiology teams.
• There’s a potential need for new communication systems and digital infrastructure to effectively manage antiamyloid mAb treatment, including possible new drug reimbursement programs.
• FDA’s decision on another antiamyloid mAb, donanemab, is anticipated by the end of 2023. If approved, clinicians will have to compare its benefits with Leqembi and other emerging mAbs, necessitating specific workflows.

Additional Points:

• Ongoing research into antiamyloid mAbs might lead to changes in patient selection, side effects, and treatment timing, demanding clinician adaptability.
• Alzheimer’s disease, being a progressive and debilitating condition with limited treatment options, may find antiamyloid mAbs as a pivotal therapeutic tool.

Conclusion:

• As Alzheimer’s disease continues to challenge the medical community, the emergence of antiamyloid mAbs like Leqembi offers a promising avenue, but it requires careful consideration and adaptability from clinicians.

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Did You Know?
Alzheimer’s disease is the 6th leading cause of death in the United States, with an estimated 5.8 million Americans aged 65 and older living with the condition in 2020.