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You may have seen news reports of a new drug, Kisunla, approved for treating Alzheimer's. The following information should help you talk with clients about it, and perhaps also help you within your own family.
Keep in mind that no drug cures Alzheimer's, reverses symptoms already present, or even permanently manages it in the way that, for example, blood pressure and cholesterol drugs manage their respective conditions. Every Alzheimer’s drug serves only to slow the progression of symptoms for a period of time, ranging from a few months to perhaps a couple of years, until the disease takes over again.
This is the third drug approved in the last couple of years, which is remarkable given that the last drug approved before these was in 2003. Of the recent three, though, one (Aduhelm) has already been discontinued. Many researchers questioned whether it should have been approved in the first place, and in further testing it did not prove to be effective.
The other two – Leqembi (Lecanemab) which was approved in January of 2024 and the just-approved Kisunla (Donanemab) – are very similar to each other. Both of them:
- Are antibodies administered only through IV infusions
- Target beta amyloid plaques in the brain
- Are only effective in the earliest stages of Alzheimer’s. Several older drugs show some slowing of symptoms in moderate cases, and there is one drug for severe cases.
- Show a 20-29% slowing of symptom progression temporarily, a decline that family members may barely notice
- Caused brain swelling and bleeding in about 20% of patients. Highest risk is for those who previously had 4 or more micro-bleeds in the brain, and those with the APOE-4 gene that is closely associated with susceptibility to Alzheimer’s. Some experts believe the risks outweigh the benefits, and most wouldn’t prescribe it to someone with two copies of APOE-4.
- Require that patients have a brain scan to determine their level of amyloid plaques, and then repeated scans to monitor both bleeding and amyloid levels
- Are expensive - $26,500/yr for Leqembi; $32,000/yr for Kisunla. Medicare and some insurance plans cover them in whole or in part, but require evidence that the patient is appropriate for this treatment.
A few differences:
- Lequembi infusions are twice a month and Kisunla once a month (requiring fewer trips to a drug infusion center)
- Patients may stop taking Kisunla once amyloid reduces sufficiently, a point that half of trial patients reached within a year and 69% in 18 months. No evidence exists yet on how long a patient could stay off before needing to resume infusions or how stopping affects symptom progression.
Bottom line: It’s good news to have more drugs approved. There are many cautions about them, however, and their efficacy is limited, so it is wise to keep one’s expectations for improvement in line with reality.
Research continues on drugs that target amyloid plaques, as well as those targeting tau tangles and neuroinflammation. Please consider joining clinical trials that further the research. See www.alz.org for many options, encompassing those who are currently fully cognitive to those in early stages who are willing to test drug effectiveness. We hope that eventually we may have more tools to use in the treatment of this devastating disease.