Hope for Alzheimer's Disease: Lecanemab

Alzheimer’s is an ongoing and progressive degeneration of cognition which destroys brain cells and slows down or halts the ability to remember, recognize, reason, use language and recall familiar places. As well, it can elicit a broad range of behavioral or personality changes.

In January 2023, the FDA gave a green light for this drug Lecanemab due to its ability to clear out amyloid plaque (fatty substances in the brain that impairs or stops information processing). Christopher Van Dyck, M.D., director of Yale’s Alzheimer’s Disease Unit was lead author of a published study (Jan. 5, 2023 issue) in The New England Journal of Medicine that shared results of a Phase lll Clinical Trial on Lecanemab. Dr. Van Dyck is also a paid consultant for Eisai, the pharmaceutical company who sponsored the trials.

This drug is sold under the brand name, Leqembi, and made by Eisai in partnership with Biogen, Inc. It is a biweekly infusion that works by neutralizing or removing a sticky protein in the brain that seems to advance Alzheimer’s. According to Dr. Van Dyck, this drug, unequivocally, slows the decline of Alzheimer’s, and it is the first time in twenty years that the FDA has granted full approval on a drug for Alzheimer’s, even though it comes with a “black box” warning due to side effects, though mild and minimal.

It is imperative to get an early diagnosis for Alzheimer’s as I have read that all medications available work best when administered “early.” In the trial utilizing 1,795 subjects, Lecanemab slowed the clinical decline by 27% after 18 months of use as compared to the placebo group. By the end of the trial study, participants showed a significant reduction (via imaging) by the end of the trial; a 26% slowing of decline in a key secondary measure of cognitive function as well as a 37% slowing of decline in daily living activities compared, again, to the placebo group.

Dr. Van Dyck, naturally, wants to see higher percentages but he does not see this as a small effect but rather as a healthy “starting point” for a bigger number of success stories down the road with longer treatment durations. Dr. Van Dyck is also experimenting on treatment with “preventative” dosages. These would be for people who are considered high risk whose MRIs have already shown brain plaque build-up (amyloid).

So far the side effects from Lecanemab are quite “benign” purely as a spin-off from the infusion delivery process. They have notated flushing, chills, fever, rash and body aches that can easily be eliminated via diphenhydramine or acetaminophen. Another issue is simply a bit of temporary fluid retention in the brain that will skew an MRI reading. They will just slow or pause the infusion until the fluid dissipates. Also, there can be mini brain bleeds which cause no real damage, according to Dr. Van Dyck.