Lecanemab

Unlike other Alzheimer's medications like donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne) which improve thinking but don't address the underlying causes, Lecanemab is a disease-modifying treatment that can preserve cognitive function and independence, helping individuals with early stage of Alzheimer's potentially maintain a higher quality of life. It delays the transition between disease stages and the onset of new symptoms and can be taken alongside other Alzheimer’s medications.

If you or a loved one are experiencing symptoms of mild cognitive impairment or mild dementia, lecanemab might be an option. Before considering treatment, UC Health’s team of physicians will assess whether you meet the criteria. Tests like lumbar puncture or specialized brain scans help determine the presence of beta-amyloid, one of several factors for eligibility. There is no evidence that lecanemab would be safe or beneficial for individuals who have beta-amyloid in spinal fluid, or on amyloid PET scans, but without evidence of cognitive change or those whose dementia is moderate or severe. 

Other dementias, such as Lewy body/Parkinson’s dementia, frontotemporal dementia, and vascular dementia, do not involve beta-amyloid and would not be helped by this treatment. Many times, individuals with Alzheimer’s proteins may also have evidence of other dementias, either by clinical symptoms or the presence of other abnormal proteins and other brain scans or MRI findings. 

At this time, it isn’t certain that lecanemab should be given to treat Alzheimer’s pathology when other dementias may be present. Additionally, people who carry a specific gene version called APOE-ε4 experience a higher risk of side effects from lecanemab. At UC Health, patients seeking treatment with lecanemab should be evaluated by one of our physicians specialized in memory disorders who can carry out all the qualifying tests and examinations. 

As with any medical intervention, there are potential risks. While lecanemab has shown promising results, about 1-2 in 20 patients experienced new symptoms that led them to stop treatment. Infusion reactions, the most common side effect, happen to around 1 in 3 patients but are usually manageable. Infusion reactions involve immune responses to drugs given through the blood and may include changes in blood pressure, changes in breathing, skin changes, fevers, and chills.

Another potential concern is ARIA (Amyloid-Related Imaging Abnormalities), affecting about 2 in 10 people. These are changes in the brain detected through MRI scans, which can lead to symptoms like headache or visual changes. There are two types of ARIA, one is called edema or ARIA-E (a leakage of fluid from a blood vessel into the brain) and the other is called microhemorrhages or ARIA-H (small bleeds into the brain). While risks exist, they are carefully monitored and managed by our team using MRI scans at frequent intervals before infusion. Most ARIAs resolve in 3-4 months and patients are still able to experience the benefits of lecanemab.  However, depending on the extent of ARIA changes on MRI and symptoms, lecanemab treatment may be temporarily or permanently stopped.  

Lecanemab should not be offered to patients with evidence of blood vessel abnormalities, bleeding disorders or other specific conditions. People who carry a specific gene version called APOE-ε4 experience a higher risk of side effects from lecanemab. A blood test for this gene is required for all patients considering treatment with lecanemab. Individuals with two copies of this gene are at very high risk for severe side effects and shouldn’t undergo this treatment. Those with one copy of this gene may weigh the benefit of the drug with the understanding that there is a greater risk of side effects.

Since there is a risk for bleeding from lecanemab, individuals on strong blood thinners, anti-coagulants like warfarin (Coumadin), apixaban (Eliquis), rivoroxaban (Xarelto) and those with bleeding disorders (such as low platelets, hemophilia, von Willebrand disease) should not take lecanemab. If a stroke occurs, “clot busting” medications should not be given when an individual is treated with lecanemab.

Lecanemab's benefits extend beyond just its immediate effects. Our ongoing research aims to understand its long-term impact and determine the best course of action for treatment. We're committed to providing personalized care and monitoring your progress using a variety of measures, including clinical evaluations and brain imaging.

Heart and vascular problems of the brain 

• During the study leading to FDA approval, individuals with mild heart, blood vessel diseases and vascular disease of the brain were included and did not differ from other participants. It isn’t known if more severe brain and heart conditions would change the benefit or risk of treatment.

Cancer 

• Cancer increases inflammation and may increase the risk for complications from lecanemab or lecanemab may increase the risk for cancer recurrence.

Sleep apnea and other sleep disturbances 

• Sleep disorders may reduce the clearance of amyloid and inflammatory proteins and reduce the benefit of lecanemab. At UC Health, all individuals who consider lecanemab treatment will undergo a sleep study to determine if sleep apnea or another sleep disorder is present and appropriate treatment will be required.

The Centers for Medicare & Medicaid Services (CMS) will provide coverage for lecanemab treatment in patients enrolled in a data registry. Patients will need to consent to have their treatment data shared with CMS before starting infusions. Most private insurers have not yet weighed in on coverage decisions. At this time, UC Health is awaiting more information about how insurance coverage will impact the overall cost of lecanemab treatments. At UC Health, your health and well-being are our priority. Our dedicated team of experts is here to guide you through every step of your journey with Lecanemab. Contact us to learn more.