Anti-amyloid monoclonal antibody treatments for Alzheimer’s disease

Lecanemab and donanemab are monoclonal antibodies designed to target and eliminate an abnormal protein, called beta-amyloid, from the brain. Beta-amyloid buildup is believed to contribute to Alzheimer’s disease onset, impacting cognitive functions such as memory, speech and reasoning, as well as motor skills, affecting daily activities such as the management of medications and finances, and the ability to drive.

Lecanemab and donanemab are not a definitive cure for Alzheimer’s disease. However, clinical studies have shown that they can slow the progression of cognitive and functional deterioration. This is in large part due to the removal of beta-amyloid from the brain.

Lecanemab and donanemab are administered intravenously every two or four weeks, respectively, at an infusion center. Each session takes about one hour.

To be eligible for this Alzheimer’s treatment, patients must meet the following criteria:

• 50 to 90 years of age
• Diagnosis of mild cognitive impairment (MCI) or mild dementia caused by Alzheimer’s disease
• Pathological/biomarker confirmation of brain beta-amyloid deposition via imaging (PET scan) or spinal fluid testing
• Absence of specific contraindications, which will be determined upon our evaluation

• Patients cannot receive lecanemab or donanemab for any of the following reasons:
• Moderate-advanced dementia due to Alzheimer’s disease
• Use of anti-coagulants/blood thinners
• Transient ischemic attack/stroke/intracranial hemorrhage in the past 12 months
• Active cancer (not in remission for at least five years, with exceptions)
• Inability to undergo brain MRI
• ApoE4/4 genotype
• Significant medical history, including:
  • Significant history of stroke
  • Seizure disorder
  • Presence of other neurodegenerative diseases
  • Presence of significant brain abnormalities
  • Hypersensitivity to monoclonal antibody treatment
  • Bleeding disorders
  • Immune/autoimmune conditions
  • Other serious or uncontrolled medical conditions

Common side effects include:

• Infusion reactions, like chills, fever, flushing, rash, headache, and changes in blood pressure
  • Typically, these resolve on their own in hours or days, but there are cases that require treatment and hospitalization.
  • Pre-medication may be required prior to infusions if there is a history of infusion reactions.

Amyloid-related imaging abnormalities (ARIA):

• ARIA can cause brain swelling or bleeding.
• ARIA can lead to mild or severe neurological signs, e.g., headache, vertigo, altered vision, focal signs (like a stroke), altered consciousness and seizures.
• Genetic susceptibility: a specific gene variant of the ApoE gene, variant 4, increases the risk of ARIA, and will be tested before the treatment.
• Monitoring: periodic brain MRIs are required for monitoring, with potential adjustments to treatment based on the results.

• Lecanemab and donanemab can be costly medications but may be partially covered by Medicare. You may also incur out-of-pocket expenses depending on your specific insurance plan and co-insurance.
• Medicare coverage requires the participation in a clinical Medicare-approved registry, which collects real-world information about the medications’ use and outcomes.
• Required imaging scans and additional tests are currently covered by insurances per standard of clinical practice; amyloid PET will be covered by Medicare and most insurance providers.
• Coverage should be verified before agreeing to treatment.

To see if you’re eligible to receive anti-amyloid treatments, fill out the form below. Patients will be promptly evaluated by our dementia care specialists (DCS).