Overview
What is monoclonal antibody treatment?
Lecanemab (Leqembi®) and donanemab (Kisunla®) are newer treatments for certain people with early Alzheimer disease. They are part of a group of medications called anti-amyloid monoclonal antibodies.
These medicines target beta-amyloid, a protein that can build up in the brain and form plaques, one of the earliest changes associated with Alzheimer disease. By helping remove some of this amyloid, treatment may slow the progression of memory and thinking problems in appropriately selected patients.
These medications are not cures. They do not stop Alzheimer disease or restore lost memory. Their goal is to modestly slow cognitive and functional decline.
Who is eligible for this treatment?
Monoclonal antibody treatments are intended for people in the early symptomatic stages of Alzheimer disease, including:
- Mild cognitive impairment (MCI) due to Alzheimer disease
- Mild Alzheimer dementia
Before treatment can begin, patients must undergo a comprehensive evaluation to:
- Confirm the diagnosis and stage of disease
- Confirm the presence of amyloid in the brain through:
- Amyloid PET imaging, or
- Cerebrospinal fluid (CSF) testing
Blood-based Alzheimer tests may be helpful during the evaluation process but are not sufficient by themselves to determine treatment eligibility.
What to Expect
How is the medication given?
Lecanemab (Leqembi®)
- Usually administered as an intravenous (IV) infusion every two weeks
- Each infusion takes about one hour
- A subcutaneous (under-the-skin) form is also available
- Eligible patients may continue on maintenance treatment after the initial treatment period of 18 months
Donanemab (Kisunla®)
- Administered as an IV infusion approximately once a month.
- Treatment is generally planned for 18 months.
- Some patients may be able to stop treatment earlier if treatment goals are achieved.
Locations
At Riverside, the lecanemab and donanemab are provided through the Neurology Infusion Centers in Newport News and Williamsburg. The Neurology Infusion Centers are located adjacent to these offices:
Riverside Neurology Specialists Newport News
12200 Warwick Blvd., Suite 110
Newport News, VA 23601
757-534-5100
Riverside Neurology & Sleep Specialists Williamsburg
120 Kings Way, Suite 2700
Williamsburg, VA 23185
757-221-0110
Treatment locations and infusion timing may change over time.
What benefits can be expected?
Clinical studies have shown that both lecanemab and donanemab slowed cognitive decline in people with early Alzheimer disease. The benefit was measured through tests of cognition and the ability to perform daily activities.
While studies show positive benefit, the impact to any individual person cannot be predicted with certainty.
- Benefits vary from person to person.
- Treatment is not expected to improve memory that has already been lost.
- Treatment is not expected to restore previous levels of independence.
- Some patients may notice a meaningful delay in progression, while others may experience less noticeable benefits.
There are currently no completed head-to-head clinical trials showing that one medication is superior to the other. Treatment and medication choice is individualized and may depend on:
- Medical history
- MRI findings
- Treatment schedule
- mMonitoring needs
- Insurance coverage
- Individual patient goals
Why doesn’t this fully control alzheimers?
Alzheimer disease involves more than just amyloid plaque buildup.
Other disease processes include:
- Tau protein tangles inside brain cells
- Brain inflammation
- Blood vessel damage
- Loss of communication between nerve cells
Because these medications target only amyloid, they cannot fully stop the disease process or prevent all progression.
What is the Risk
ARIA and APOE Testing
Like all medications, monoclonal antibody therapies carry potential risks and side effects.
The most important possible side-effect of this treatment is amyloid-related imaging abnormalities (ARIA), ARIA may appear on an MRI brain scan as temporary brain swelling or small areas of bleeding. Most patients doe not develop serious complications and many cases identified on MRI do not cause symptoms.
However, ARIS can occasionally be serios and may cause symptoms such as:
- New or worsening headaches
- Confusion
- Dizziness
- Vision changes
- Difficulty walking
- Weakness
- Speech changes
- Seizures
A gene called APOE can influence a person's risk of developing ARIA. For this reason, APOE genetic testing is performed before treatment.
Your neurologist will review genetic testing results and discuss what they may mean for your treatment plan.
MRI monitoring and other safety considerations
Brain MRI scans are required before treatment begins and at specific points during therapy to monitor for ARIA and other potential concerns. The number and timing of scans depend on the medication used, current prescribing information and the individual patient circumstances. Some MRI findings or medical conditions may make treatment inappropriate. Patients should also tell their care team about all medications, supplements, and medical conditions. Blood-thinning medications and certain other health conditions or medications may increase the risk of treatment-related complications.Make an informed decision
Starting monoclonal antibody treatment is a personal decision that should be made together with the patient, care partner, and healthcare team. Discussions should include:
- Expected benefits
- Potential risks
- MRI and follow-up monitoring requirements
- Insurance coverage and authorization requirements
- Individual goals and preferences
Because Alzheimer treatments and recommendations continue to evolve, eligibility and treatment decisions should be based on the most current evidence and an individualized evaluation by a qualified healthcare provider.