Lecanemab has received worldwide attention as the latest approved medication for Alzheimer’s disease and the first FDA-approved treatment for Alzheimer’s in more than 20 years. Donanemab, another in-class medication, is under review for a similar approval. It’s anticipated that approval will occur within the year. Vijay Ramanan, M.D., Ph.D., a behavioral neurologist at Mayo Clinic in Rochester, Minnesota, says it’s important to view these newest options as potentially part of an overall treatment plan.
“We try not to make any treatment option an all-or-none discussion with patients because managing Alzheimer’s disease should be a comprehensive process,” Dr. Ramanan says.
New developments in Alzheimer’s disease treatment options make World Alzheimer’s Month in September particularly timely.
What the new Alzheimer’s medication means for patients
Lecanemab shows promise in removing amyloid plaques from the brain, which are early markers of Alzheimer’s disease. In its clinical trial, lecanemab treatment over 18 months modestly slowed the progression of cognitive decline, but it is not for everyone, according to Dr. Ramanan.
“Lecanemab is only appropriate for patients confirmed to have relatively mild stages of Alzheimer’s disease,” he says. “There is no evidence to support using the drug in patients with more advanced stages of the disease or in patients with normal cognitive functioning.”
Patients will get lecanemab every two weeks by IV and undergo regular MRIs to check for brain swelling and/or bleeding, a side effect known as amyloid-related imaging abnormalities, or ARIA.
“The prospect of having something that slows disease progression by removing amyloid plaque — an important element of the disease — rightfully makes the medication of interest,” says Dr. Ramanan. “But these drugs are complex and will not be the right option for every patient, highlighting the need for nuanced and individualized discussions in the clinic.”
The importance of family support and lifestyle strategies
For some patients considering lecanemab, committing to regular infusions and periodic MRIs may not match their current lifestyle or goals and, according to Dr. Ramanan, shared decision-making with patients and their loved ones about these nuances should be discussed.
Even if the patient does not proceed with the new medication, they can incorporate other medication treatments for Alzheimer’s disease and lifestyle strategies to help the brain. Those lifestyle habits include regular physical activity, staying socially engaged, keeping mentally active, maintaining a balanced diet and getting a good night’s sleep.
“These all sound like the basics, but the fundamentals that are good for your heart and your brain really do impact health over the long run,” Dr. Ramanan says.
The future of Alzheimer’s treatment
Dr. Ramanan says, in the future, patients with Alzheimer’s disease might need specific combinations of medications depending on their symptoms and other factors, such as patients with high blood pressure, HIV or other complex diseases.
According to Dr. Ramanan, research into tau protein, which builds up in the brain, is garnering intense interest in the field. How and when tau builds up in the brain is closely linked to the types and timing of symptoms. Early clinical trials are underway to see if delivering drugs to the nervous system can reduce tau accumulation, among other strategies.
“We recognize there aren’t cures yet for Alzheimer’s and related diseases, nor are there yet full, complete prevention strategies for them,” he says. “But just like with other diseases, the future will almost certainly require a combination of lifestyle strategies and, hopefully, ever-improving medication therapies.”
