Lecanemab (Leqembi)
Central Nervous System Agent | Monoclonal Antibody
Indication and Efficacy:
- Leqembi is approved for the treatment of mild cognitive impairment or mild dementia stage of Alzheimer’s disease. It is targeted towards patients who have confirmed presence of amyloid beta pathology. Clinicians should verify amyloid status before initiating treatment.
Mechanism of Action:
- Leqembi is an anti-amyloid beta (Aβ) protofibril antibody that selectively targets soluble aggregated forms of amyloid beta, including oligomers and protofibrils, which are believed to be highly neurotoxic. Understanding this can help in explaining the therapeutic approach and expected outcomes to patients and caregivers.
Administration:
- The drug is administered by intravenous infusion every two weeks. Consistent scheduling is crucial to maintain therapeutic levels and efficacy. Educating patients about the regularity and duration of treatment at the outset is important to manage expectations and encourage adherence.
Monitoring and Side Effects:
- Regular monitoring for amyloid-related imaging abnormalities (ARIA) is essential, especially ARIA-E (edema) and ARIA-H (microhemorrhage). This requires MRI scans before the fifth and seventh infusions and then based on clinical indications.
- Common side effects include infusion-related reactions such as headache, fatigue, and nausea. Pre-medication and timely management of side effects are crucial for maintaining patient comfort and adherence.
Drug Interactions and Contraindications:
- Currently, there are no known significant drug interactions, but vigilance is necessary as more data becomes available. Assess all medications the patient is taking for potential interactions.
- Contraindications are primarily related to hypersensitivity reactions to the product. Detailed patient history regarding allergic reactions should be recorded to avoid adverse effects.
Patient Education and Support:
- Healthcare providers should ensure that patients and their caregivers are adequately educated about Alzheimer’s disease, the role of Leqembi, its potential benefits, and side effects. Continuous support and counseling should be provided to help manage expectations and emotional responses.
Efficacy Metrics:
- Discuss with patients and caregivers the realistic outcomes of using Leqembi, emphasizing that the treatment aims to slow down, but not cure, the progression of Alzheimer's. Clinical measures of cognition and function, along with anecdotal feedback from caregivers, can be valuable in assessing the drug’s impact.
https://www.leqembi.com/-/media/Files/Leqembi/Prescribing-Information.pdf -
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