The FDA recently approved a new drug in the treatment of Alzheimer’s disease. Lecanemab is being sold under the brand name Leqembi by its manufacturer, Eisai.
At this time, there is no cure for Alzheimer’s disease. It is considered a progressive, fatal disease. The benefit of Leqembi is that it will slow the progression of the disease for some patients in early stages, perhaps only by months. However, for some, even having a limited amount of extra time at the beginning of symptoms may allow patients to get their finances, power-of-attorneys, and personal affairs in order before they are unable to do so.
More than 6.5 million Americans are affected by Alzheimer’s disease. As the illness progresses, patients require three to five caregivers to support their daily living needs such as toileting, showering, and with meal assistance in addition to protecting them from harm such as falling down stairs, dangerous use of kitchen items, wandering into traffic, leaving the house unattended and getting lost, etc.
Causes of Alzheimer’s include the formation of amyloid beta plaques and neurofibrillary tangles, both of which destroy neurons and therefore, results in the loss of memory, cognition, and the ability to perform daily life skills. Leqembi is believed to reduce this destructive amyloid plaque in the brain.
On June 9, an FDA committee voted unanimously that the results of the clinical study verified the benefit of Leqembi for the indicated use. Of the 1,800 patients in the study, lecanemab slowed cognitive decline on an average of 27% over 18 months.
Of course, as is the way of pharmaceutical drugs, there are challenges in drug administration and side effects. Patients on Leqembi require infusions every two weeks and careful monitoring thereafter. The medical field is short on physicians trained in caring for memory care patients as well as centers to administer the infusions. And Medicare coverage of necessary scans to monitor the drug’s effect on the brain is limited.
The most common side-effects of Leqembi are headaches, infusion-related reactions, and abnormal imaging. There also may be confusion, dizziness, vision changes, and nausea. One in five patients who participated in the clinical trials experienced brain swelling and/or bleeding, at least three of which resulted in death.
The excitement over this new drug is understandable since there is so little that can be done to prevent or control Alzheimer’s disease. Every small step has the potential to bring us closer to one that powerfully impacts the future.
The most curious concern for me is that the drug should be initiated in patients with mild cognitive impairment or mild dementia stages of Alzheimer’s. People with Alzheimer’s disease have little awareness of their limitations, so I’m not sure they would be able to seek the drug if they wanted the option.
You may remember from prior posts that my husband, Marshall, had symptoms of Alzheimer’s disease for at least 15 years prior to his death. Yet, while immobile and bed-ridden, he declared then that he was still walking, working, and self-sufficient.
Being self-aware of the smaller changes in cognition is nearly impossible for those living alone to recognize. (Alzheimer’s disease begins destroying the brain 10 to 20 years before symptoms become evident.) Even couples together for decades rarely understand the first few years of symptoms. I know I did not. Having little understanding of Alzheimer’s disease at the onset of Marshall’s symptoms, I dismissed his moodiness, constant loss of items, and forgetfulness as being too busy, careless, or uncaring. And he never became aware of his disability.
In my opinion, the best option for the use of Leqembi would be for patients who see their doctors yearly for exams, and doctors who identify the symptoms—which would mostly be because of patients self-recognition of symptoms and reporting them to the doctor—as well as doctors following through with a prescription for the drug. And then it would be the patient’s decision if it is worth the potential side-effects and time as well as their ability to remember and conform to the need for the infusions of the drug every two weeks.
The Alzheimer’s Association is a trusted source of information on the disease. You can read more about Leqembi on their website.
*For more information about caring for a loved one with Alzheimer’s, see the following books I’ve written on the topic.
Navigating Alzheimer’s which describes the challenges caregivers face and offers solid guidance in regard to the caregiver’s most pressing concerns.
The Alzheimer’s Spouse which offers understanding, practical guidance, credible data, and honest stories from my personal experience of caring for Marshall.