In Beating the Dementia Monster, we discussed the promise of the monoclonal antibody treatment BAN2401. Since then, it has become more widely known generically as lecanemab, and then commercially as Leqembi. When administered to patients with early stage Alzheimer's disease, it appears to be more effective than Aduhelm. Aduhelm is generally priced at $28,200 per year, while Leqembi is priced at $26,500 per year. Aduhelm is administered intravenously every four weeks, while Leqembi is received intravenously every two weeks. Both require regular MRIs to check for brain swelling and microhemorrhaging. We mentioned before that three patients died during the lecanemab trials, although there is dispute over cause of death for at least two of these cases.
I recently received an email from James, one of the subscribers to this blog, noting that the Veterans Administration has now approved Leqembi for some veterans with early stage Alzheimer's disease. The news was reported in this article from Military.com. The article acknowledges that drug trials so far have found that, like Aduhelm, Leqembi effectively removes amyloid plaques, but testing to determine how well it improves memory and cognition is still in progress. Trials for both treatments are incomplete, but, so far, there are better results with Leqembi than with Aduhelm.
Looking more broadly at the pharmacological approach to treating Alzheimer's disease, the question still remains whether treating amyloid plaques is addressing the actual disease mechanism or a just a symptom. Removing the plaques doesn't cure the disease, although it improves memory and cognition. As we discussed before, some researchers propose that the plaques are actually a defense mechanism against the real culprit(s), certain microbes that have entered the brain. As we discussed in Beating the Dementia Monster, these may be the herpes virus or the p. gingivalis bacteria.
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