UW Medicine’s Memory and Brain Wellness Center treated its first patient with the new Alzheimer’s drug, lecanemab, on Dec. 1. The drug has been shown to reduce cognitive decline in patients with early Alzheimer’s disease.
Doug Davidson, of Mount Vernon, Wash., was the first patient to receive the intravenous drug at UW Medicine.
“I’m pleased that Harborview Medical Center is one of the first West Coast hospitals to administer the IV infusion treatment to our qualifying patients,” said Dr. Thomas Grabowski, a professor of radiology and neurology at the University of Washington School of Medicine. A behavioral neurologist, Grabowski is medical director of the Memory and Brain Wellness Center, based at Harborview.
Lecanemab (sold under the brand name Leqembi) was approved this year by the U.S. Food and Drug Administration.
In January, the New England Journal of Medicine published clinical-trial findings that showed treatment with lecanemab reduced the amount of amyloid in the brains of patients with early Alzheimer’s and slowed their cognitive and functional decline.
“Though the outcome was relatively modest — a 27% slowing of cognitive decline and functional decline over 18 months — this is still a step in the right direction,” said Dr. Michael Rosenbloom, associate professor of neurology at the UW School of Medicine and director of clinical trials at the Memory and Brain Wellness Center.
Although lecanemab is not a cure, it is the first FDA-approved drug shown to modify the course of this disease.
“When I became a behavioral neurologist over 13 years ago, the idea of having a disease-modifying drug sounded like science fiction,” Rosenbloom said.
Lecanemab is an antibody that binds to proteins called amyloid-beta, which accumulate in the brains of people with Alzheimer’s. These proteins form insoluble clumps called amyloid plaques, which are believed to contribute to brain deterioration. By binding to these proteins, lecanemab stimulates the patient’s immune system to remove the amyloid.
Lecanemab is approved for use by patients who have amyloid plaques and mild cognitive impairment or very mild Alzheimer’s dementia. The presence of amyloid can be determined either by a radiological imaging test called a PET scan or by testing spinal fluid for the protein’s presence.
The drug has not yet been shown to benefit people who have amyloid in the brain but no symptoms, people who have moderate to severe Alzheimer’s, or people with vascular and other dementias. Clinical studies so far have only reported the results of 18 months of treatment; beyond that it is unknown how long its benefits might persist.
Lecanemab is administered by intravenous infusion every two weeks for up to 18 months. Patients are monitored with MRI scans to ensure they are not experiencing possible side effects known as amyloid-related imaging abnormalities (ARIA).
In the clinical trial of lecanemab, about 13% of patients developed ARIA. Most, however, did not have symptoms and were able to complete the treatment. The long-term effects of ARIA, however, are unknown.
Eligible patients who are considering the treatment should understand that lecanemab’s benefits are modest and might even be hard to notice, and that there is risk of developing ARIA. Treatment requires twice-monthly visits to a clinic for IV infusion and is not covered by all insurance plans.
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