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1- A thread on the value of treating #Alzheimer’s disease w/ monoclonal antibodies:
As I read through the recently published appropriate use guidelines for #lecanemab, I am struck by the infrastructure & resources that will be necessary.
#GeriTwitter
link.springer.com/article/10.142….
As I read through the recently published appropriate use guidelines for #lecanemab, I am struck by the infrastructure & resources that will be necessary.
#GeriTwitter
link.springer.com/article/10.142….
2- This table summarizes what medical centers need to safely administer lecanemab to people with Alzheimer’s disease.
Lecanemab is given via IV infusion every two weeks. This requires having an infusion center with the needed capacity & appropriately trained staff.
Lecanemab is given via IV infusion every two weeks. This requires having an infusion center with the needed capacity & appropriately trained staff.
3- Before treatment begins, you need to make a diagnosis.
You need clinicians skilled at diagnosing mild cognitive impairment & mild dementia.
These are usually neurologists but could be geriatricians or geriatric psychiatrists. There aren’t a ton of folks with this skillset.
You need clinicians skilled at diagnosing mild cognitive impairment & mild dementia.
These are usually neurologists but could be geriatricians or geriatric psychiatrists. There aren’t a ton of folks with this skillset.
4- Because the treatment involves clearing amyloid from the brain, you have to demonstrate the person has amyloid.
This involves either a lumbar puncture or an amyloid PET. Medicare does not cover the latter.
This involves either a lumbar puncture or an amyloid PET. Medicare does not cover the latter.
5- The appropriate use guidelines also recommend genotyping because people who are Apo-e4 positive are at higher risk of the complication ARIA.
That in turn requires genetic counseling for the people tested and perhaps for their children.
That in turn requires genetic counseling for the people tested and perhaps for their children.
6- Then there are the MRIs.
Because of the risk of ARIA (either brain edema or microhemorrhages), the person must get an MRI at baseline, several times during the course of treatment, and whenever they have symptoms that could be ARIA.
Because of the risk of ARIA (either brain edema or microhemorrhages), the person must get an MRI at baseline, several times during the course of treatment, and whenever they have symptoms that could be ARIA.
7- You also need radiologists trained to detect & grade ARIA.
You also need emergency room clinicians & neurologists who can diagnosis & manage ARIA.
You also need emergency room clinicians & neurologists who can diagnosis & manage ARIA.
8- I am just not sure this is all worth it.
Alzheimer’s is a devastating disease but lecanemab has only very modest benefit in slowing the decline. We don’t expect improvement in memory or functioning.
We certainly need effective treatments, but I don’t think this is the way.
Alzheimer’s is a devastating disease but lecanemab has only very modest benefit in slowing the decline. We don’t expect improvement in memory or functioning.
We certainly need effective treatments, but I don’t think this is the way.
9- Finally, imagine using all the money that will be required for antibody treatments instead for community resources for older adults, caregiver supports, & interventions for behavioral & psychological symptoms of dementia.
That would be a great investment.
That would be a great investment.
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