Hospitals make massive strides in treatment of Alzheimer’s
It wasn’t long ago when a diagnosis of Alzheimer’s disease was not too far from a death sentence.
While treatments have existed for years, they could manage only the individual symptoms caused by Alzheimer’s and could do nothing to stop or reverse the progressive neurological damage the disease causes to the brain.
That has changed recently after the Food and Drug Administration gave its approval to two new medications, lecanemab in July 2023 and donanemab in July 2024, which are intended to treat what is believed to be the underlying cause of Alzheimer’s — the buildup of amyloid proteins within the brain.
As a result, Independence Health System — which includes Butler Memorial Hospital — has implemented an Alzheimer’s treatment program that includes infusions of one of these new wonder drugs.
“What’s exciting is there are new drugs now available when there hasn't been anything new for a very long time,” said Dr. Mary E. Kovacik Eicher, neurology specialist at Independence Health.
There are subtle differences between the two drugs, and Independence Health distributes the drugs to patients depending their individual situation. They are not to be administered together.
For example, lecanemab is meant to be given once every two weeks, while donanemab is meant to be administered once a month. Lecanemab infusions last one hour, while donanemab infusions last only 30 minutes, with an extra 30-minute period of observation for side effects afterward.
“You choose one or the other, and that choice is made upon verifying that there is amyloid present, and then a risk-versus-benefit discussion with your neurologist about whether this is a drug that is right for you, based on all kinds of different things, like your medical history, the medications that you're on, your age, et cetera,” Eicher said. “And then patients and their provider will together choose which one of the two infusions they would take.”
Of course, since these are new drugs, doctors are watching closely for side effects. The main one associated with the two new Alzheimer’s treatments is called ARIA — amyloid-related imaging abnormalities. These are spots on MRI scans which show hemorrhages or swelling.
To detect whether ARIA is present, patients undergo frequent MRI scans throughout their infusion-treatment process.
“As these medicines go in, it can cause sort of a reaction in that area,” Eicher said. “Areas can get swollen, or they can bleed a little bit.”
Eicher said most cases of ARIA are asymptomatic, with the patient presenting no symptoms. However, this isn’t always the case.
“There is a risk of what’s called symptomatic ARIA, or symptomatic bleeding and swelling,” Eicher said. “If you have a certain history, or if you’re on a blood thinner, that might increase the risk.”
Lecanemab has a documented ARIA rate of 21%, with 3% symptomatic, and donanemab has an abnormality rate of 36%, with 6% symptomatic.
Not all Alzheimer’s patients may be suited for a treatment program that involves infusions of one of these two drugs. In fact, the drugs are intended for those who are in the early stages of the disease. Eicher said Independence facilities evaluate patients to ensure whether they are candidates for infusion therapy before deciding to go through with it.
“A patient might find that they’re not willing to take the risk, because there are risks with it,” Eicher said. “These drugs have been tested in the earliest stages of Alzheimer’s, so they would not be a candidate if the disease is in a more-advanced stage.”
Infusions take place at two Independence Health facilities — Butler Memorial Hospital and Westmoreland Hospital in Greensburg.
The University of Pittsburgh Medical Center’s Neurological Institute also offers an Alzheimer’s treatment program which features infusions. UPMC offers lecanemab in its Alzheimer’s treatment plan, but not donanemab.
