Immunotherapies for Treating Alzheimer’s Disease
As part of our Cognitive Neurology unit, the DiAD clinic specializes in advancing and implementing treatments for patients with Alzheimer’s disease. Under the care of our center, patients are given new hope through monoclonal, anti-amyloid therapy. We are the first hospital in the Commonwealth to treat Alzheimer’s disease patients with lecanemab. We evaluate patients for eligibility for anti-amyloid immunotherapies and treat and follow patients through our DiAD clinic.
Our Team
The DiAD Clinic within the Cognitive Neurology Unit at Beth Israel Deaconess Medical Center and Harvard Medical School comprises a diverse team of specialists including cognitive neurologists, neuropsychiatrists, neuropsychologists, and clinical social workers. As clinicians, educators, and researchers, we aim to deliver advanced care, educate clinicians and trainees, and advance knowledge in neurological and neuropsychiatric disorders. Our subspecialty clinics cater to diverse patient needs, offering bicultural and bilingual support, innovative diagnostic and treatment approaches, and the latest interventions.
What is lecanemab?Lecanemab is an antibody therapy that removes a protein called beta-amyloid from the brain. Patients with Alzheimer’s disease (AD) have a build-up of the protein, beta-amyloid in their brain. This build-up is thought to play an important part in the progression of AD. Decreasing beta-amyloid with lecanemab has been shown to slow the progression of AD.
How effective is lecanemab?Lecanemab is not a cure for AD and it will not improve your thinking. However, it can slow down the decline in your thinking and memory and your ability to do daily activities by about 30% over 18 months.
Who is eligible for lecanemab?Patients with mild cognitive impairment or early stage of dementia from Alzheimer’s disease are eligible. This diagnosis needs to be made by a medical provider and confirmation of the presence of the protein amyloid needs to be obtained. Lecanemab is not recommended for everyone. For example, patients with a high risk of bleeding or who take blood thinning medications may not be eligible
What are the costs? Lecanemab infusions cost $26,500 annually, of which basic Medicare will cover 80% of the cost. Every insurance plan is different and may have different coverage.
How is lecanemab given and what happens if I decide to take it?Lecanemab is given through a 1-hr infusion every 2 weeks for 18 months, but will require you to be at your infusion center for a few hours for each infusion. In addition to the infusion visits, you will have at least 3 MRI brain scans and 9 clinic visits over the course of 18 months.
What happens if I decide I am interested in lecanemab?Everyone interested in lecanemab will be evaluated for appropriateness of this medication. You will undergo a series of stepwise clinic visits and tests to understand whether this medication is right for you. This may take a few weeks to months to complete.
We may find out along the way that lecanemab is not right for you
What happens at your first visit? You will see a lecanemab neurologist to:
- Review your medical history and medications
- Do a neurologic exam
- Order a blood test for your APOE genotype
- Order an MRI if not done recently
You will meet with a neuropsychologist to:
- Discuss your memory in detail
- complete cognitive tests of your thinking and memory.
This evaluation will help us to better understand your memory problem.
What happens next?After this, you will follow-up with your lecanemab neurologist to review the results of your testing. If you decide to continue, and it is safe for you to do so, you will undergo a test to check for the presence of amyloid in the brain. Your lecanemab neurologist will review the results with you, and together, you can decide if lecanemab is right for you.
Understand the risks and side effects of lecanemab Before receiving lecanemab, it is important to understand potential side effects of the medication. Two main concerns while receiving lecanemab are infusion reactions, and brain bleeding and swelling.
Infusion Reactions
Infusion reactions occur when your body and immune system reacts to a treatment that is given intravenously (IV). Lecanemab is a treatment that can cause infusion reactions.
- Infusion reactions are typically mild-moderate and occur during or after the first few infusions. Symptoms usually resolve on their own within 24 hours and can be managed at home.
- You will be monitored for any reactions. If you have a reaction, you may be treated with medications and your infusion stopped.
- Symptoms that can be associated with infusion-related reactions:
- Fever
- Flu-like symptoms
- Rash
- Nausea, vomiting
- Dizziness or lightheadedness
- Changes in your heart rate
- Difficulty breathing
- An infusion reaction does not always mean you have to stop treatment. More likely, if you have an infusion reaction, we will treat you with medication prior to your next infusion.
Brain Bleeding and / or Swelling - ARIA
A potential side effect of the treatment is brain bleeding and swelling . This is likely due to
the way lecanemab works to remove amyloid from the brain.
- This brain bleeding and swelling is known as Amyloid Related Imaging Abnormalities (ARIA). This is seen on brain imaging and does not always cause symptoms.
- Usually, ARIA is temporary, mild-moderate in severity and resolves on its own over time. However, it can lead to serious symptoms.
- ARIA typically occurs in the first 6 months of treatment. However, it can occur at anytime and it can re-occur after resolving.
- In the clinical trials, 21% of patients had ARIA, but only 3% of these patients had symptoms.
- Brain bleeding and swelling is more likely to occur in patients who:
- Have two copies of the APOE-e4 gene,
- Are taking certain medications like blood thinners
- Have/had certain changes in their brain seen in imaging.
- During your evaluation period, you will undergo multiple tests to help us better understand your risk associated with receiving lecanemab.
- Because there is often no symptoms associated with brain bleeding or swelling, routine MRIs at specific time intervals will monitor for these changes.
When symptoms are associated with brain bleeding or swelling, they may include:
- Headache
- Confusion
- Dizziness
- Vision changes
- Nausea
- Difficulty walking / gait changes
- Rare, but more serious symptoms include:
- Seizure
- Stroke-like symptoms: speech changes, facial drooping, arm/leg weakness or numbness, severe headache, sudden or severe confusion
What happens if I develop ARIA?
You will be monitored closely by your lecanemab team.Your lecanemab team will work with you to determine if your symptoms may be related to ARIA and discuss with you the next best steps. We will use MRIs and clinical visits to monitor you and your symptomsDepending on the severity of your ARIA – a combination of symptoms and changes shown on your MRI – you may have to stop your infusionsYou may be able to resume your infusions after this resolves Cognitive Neurology Unit at Beth Israel Deaconess Medical Center and Harvard Medical School Team
