The Food and Drug Administration (FDA) has approved lecanemab for the treatment of Alzheimer’s disease at the earliest symptomatic stages. This medication is one of the first disease-modifying therapies approved for the treatment of Alzheimer’s Disease in the United States.
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Marketed as Leqembi, lecanemab is now available to appropriate patients and covered by most insurance plans.
Lecanemab slows the progress of Alzheimer’s disease. It dissolves plaques that can build up between brain cells, or neurons, and are widely thought to cause Alzheimer’s symptoms. More technically, it is a monoclonal antibody targeting beta-amyloid. These amyloids can for the plaques that can interfere with brain function.
Anti-amyloid therapies are medications designed to remove a protein called beta-amyloid from the brain. This protein is thought to be involved in the development and progression of Alzheimer’s Disease.
It is given through a vein every two weeks and has been shown to slow the progression of Alzheimer’s disease by about 30%.
Lecanemab is indicated for patients with Alzheimer’s in the mild or early stage of Alzheimer’s disease. An assessment of medical history, a magnetic-resonance imaging (MRI) and minor blood work are required to determine whether lecanemab is appropriate for you. Additional testing such as a spinal fluid examination though a PET scan and a genetic test can determine the risk of irregularities significant enough to show up in imaging tests (amyloid-related imaging abnormalities, or ARIA).
If you think you are eligible for lecanemab, talk to your primary care provider, neurologist or memory care provider. Your provider can make a referral to the Norton Neuroscience Institute Memory Center to determine whether you are eligible.
There are a number of medications in development to treat Alzheimer’s disease. While all of these medications target amyloid development, lecanemab targets the protofibrils that may be the most toxic form of amyloid.
Infusion reactions: About a quarter of patients will experience a mild infusion reaction. Symptoms might include fever, headache, rash, nausea or abdominal discomfort. These symptoms can usually be controlled with medications such as Tylenol of Benadryl if necessary.Amyloid related imaging abnormalities (ARIA): ARIA is a condition that indicates swelling or bleeding in the brain. This occurs in about 2 in 10 people receiving lecanemab, though most often causes no symptoms and resolves without any treatment. However, more severe cases can occur, leading to symptoms such as headache, confusion, visual changes, dizziness, nausea and seizures. In rare cases, this can lead to death.Because of the risk of bleeding, this medication is not recommended for patients receiving strong blood thinners. Also, those receiving lecanemab should not receive clot-busting medications.
Lecanemab is given intravenously (IV) every two weeks in an infusion center. The infusion takes less than an hour with a period of monitoring for reactions after. Home infusions may be an option after an initial series of center-based infusions. Repeat MRI scans can be completed 3 to 4 times during the first year to monitor for any side effects.
Lecanemab will not improve memory but appears to slow the progression of Alzheimer’s disease. The goal is that individuals receiving this medication will retain their memory and cognitive function longer.Ultimately, the FDA approval of this drug makes it more accessible to patients through Medicare, Medicaid and private insurance. As more patients are prescribed the drug, more research and clinical trials can advance the treatment of Alzheimer’s disease. Eradication of the disease is the hope.“I think it is a very significant step forward for our field. It’s the first time that we have had a medication with very solid evidence that it is really modifying the course of this disease and, at least as many of us think, treating the underlying causes of this disease.” Gregory Cooper, M.D., Ph.D., medical director of the Norton Neuroscience Institute Memory Center.
The FDA has granted approval for this medication as of July 6th, 2023 and it is currently covered by Medicare. Norton Healthcare is in the process of clarifying issues related to insurance reimbursement and requirements for patients receiving lecanemab to be enrolled in a registry. Norton Healthcare plans to begin offering this medication in the fall of 2023.
Reviewed by Gregory Cooper, M.D., Ph.D.
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