Stephen P. Salloway, MD, MS, Butler Hospital & Warren Alpert Medical School of Brown University, Providence, RI, explains the appropriate sse recommendations for lecanemab in the clinical setting, that have been put together by an expert panel. Lecanemab is approved in the United States for patients with early Alzheimer’s disease, but has been identified as having significant risks. The key recommendations are to select appropriate patients, know how to monitor treatment response, and discuss with patients and their families the benefits and risks. Firstly, to ensure appropriate patients are selected, cognitive assessment (MMSE 22-30) and confirmation of amyloid build-up by PET or cerebrospinal fluid (CSF) are required. It is stressed that clinicians must ensure no criteria used for exclusion in the lecanemab clinical trials are present in the patient. Building on the FDA guidance, the recommendations suggest that no patient receiving anti-coagulants should begin lecanemab treatment, given the risk of major hemorrhage. The devised guidelines also state how to monitor and manage amyloid related imaging abnormalities (ARIA), by firstly testing APOE4 status. This interview took place at the AD/PD™ 2023 congress in Gothenburg, Sweden.
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