Lecanemab (brand name Leqembi), is a medication for Alzheimer’s disease, approved by the Food and Drug Association (FDA) July 6, 2023. Lecanemab is a monoclonal antibody that removes buildup of a protein called amyloid that contributes to the development of Alzheimer’s disease. This treatment is not a cure for Alzheimer’s but can delay progression of the disease. The neurology department at UMass Memorial Medical Center is pleased to announce the availability on our University Campus.

This medication was approved for patients with mild cognitive impairment or mild dementia and confirmed presence of amyloid beta pathology. Patients with moderate or severe dementia or other diagnosis are not eligible. Before you start lecanemab your doctor within the neurology department at UMass Memorial Medical Center will need to conform the presence of amyloid in your brain. This is done by PET scan or spinal tap and blood work.

This drug is known to cause brain swelling or hemorrhage in about 20% of patients. These conditions may be diagnosed as either:

• Amyloid related imaging abnormality-edema (ARIA-E)
• Amyloid related imaging abnormality-hemorrhage (ARIA-H)

Patients on blood thinners may be at a higher risk for more serious side effects. Patients who have a specific genetic variation, APOE4 are also at higher risk for ARIA, so genetic testing prior to receiving treatment is required. ARIA is also more likely to occur within the first 14 weeks of treatment. Most patients who develop ARIA will show no symptoms associated with it. Those who do develop symptoms related to ARIA may experience:

• Headache
• Confusion
• Dizziness
• Vision changes
• Nausea
• Difficulty walking
• Seizures

Safety monitoring for ARIA will require frequent MRI scans to be interpreted by an American Society of Neuroradiology ARIA-Educated Practitioner to determine ARIA risk.

Infusion-related reactions can occur about 20% of people treated with lecanemab and most occurred with the first treatment. These symptoms can include:

• Fever and flu-like symptoms (chills, generalized aches, feeling shaky, joint pain)
• Nausea
• Vomiting
• Low blood pressure
• High blood pressure
• Low oxygen levels in the blood

Approximately 40% of patients treated with lecanemab also had a temporary decrease in lymphocyte count and 20% had an increase in neutrophil counts. Safety monitoring will include laboratory blood tests.

Lecanemab is IV infusion every 2 weeks administered in the infusion center at UMass Memorial Medical Center.

The cost of lecanemab is $26,500 annually per patient. Currently Medicaid Part B requires a 20% co-pay meaning there are still out-of-pocket costs for the medication. Additional costs for IV administration, monitoring and regularly scheduled MRI brain are still being determined. In addition, private insurance companies are still determining coverage for this medication and policies will vary. Of note Eisai, the manufacturer of lecanemab does offer payment support.

As outlined above, there will be a very detailed process for being prescribed lecanemab through the neurology department at UMass Memorial Medical Center. Although the FDA has approved and CMS has announced medication coverage for lecanemab, this medication is not going to be immediately available. There may be local centers advertising availability of lecanemab, but our first goal for new use of lecanemab is to "do no harm" and provide the safest possible care. As such, we will follow certain protocols before prescribing lecanemab at any location. Additionally, our pharmacy and administrative teams are actively meeting to determine the UMass Memorial locations that will offer lecanemab treatment.

UMass Memorial Medical Center and the department of neurology are committed to providing our patients with the most up to date Alzheimer’s treatment. Not all neurology providers in the UMass system will be prescribing lecanemab. If you provider does not prescribe this medication, we will help refer you to someone who does.