New Alzheimer’s Drug In Malaysia May Slow Disease Progression By Eight Years | SJMC

Lecanemab, a new Alzheimer's drug recently approved in Malaysia, shows great promise for patients with early Alzheimer’s by slowing disease progression, potentially by over eight years. The treatment doesn't cure disease, but buys time for patients.

Dr Chin Ai-Vyrn

KUALA LUMPUR, March 31 — A new Alzheimer’s drug for early symptomatic patients, just approved for use in Malaysia, may slow disease progression by more than eight years.

The finding about lecanemab, an immunotherapy for treating early Alzheimer’s disease, was based on data recently presented at the Clinical Trials on Alzheimer’s Disease meeting in San Diego, United States.

CodeBlue took the opportunity to speak with Dr Chin Ai-Vyrn, a consultant geriatrician and internal medicine physician at Subang Jaya Medical Centre (SJMC), who was the first doctor in the country to administer this medication, to learn more about lecanemab.

Alzheimer’s disease is the most common form of dementia, affecting patients’ memory, thinking, and behaviour. Until recently, treatments for Alzheimer’s disease have been symptomatic, providing a temporary cognitive boost without affecting the progression of the disease. Lecanemab, however, is a disease-modifying treatment that can actually affect how the disease progresses.

"Lecanemab is a very promising advance in the treatment of Alzheimer's disease," Dr Chin told CodeBlue.

"The evidence from clinical trials and real world studies show that lecanemab changes the trajectory and slows the progression of Alzheimer's disease. By doing so, it helps patients with early symptomatic Alzheimer's disease remain independent for longer."

Lecanemab, a humanised IgG1 monoclonal antibody, is categorised as an anti-amyloid therapy.

The drug, which is only approved for early symptomatic Alzheimer’s disease, received United States’ Food and Drug Administration (FDA) approval in January 2023.

In Malaysia, lecanemab received full approval from the National Pharmaceutical Regulatory Agency (NPRA) last January . SJMC is the first centre in the country to use the drug.

The Science Behind Lecanemab: How It Works

Knowing a little about the underlying pathological process in Alzheimer’s disease helps in understanding why doctors looking after patients with early Alzheimer’s disease are so optimistic.

Dr Chin explained that the disease is characterised by the abnormal accumulation of certain proteins in the brain, starting with a protein called amyloid. This leads to the accumulation of another protein called tau, and this protein accumulation causes cognitive dysfunction and loss of brain cells.

“Lecanemab is an antibody that targets amyloid. It's given through the bloodstream and passes the blood brain barrier into the brain.”

“It then binds to the amyloid protein, and this stimulates our immune system to then remove this protein from the brain itself. So it gets rid of this protein, the amyloid protein from the brain,” Dr Chin said.

Lecanemab however, doesn’t cure Alzheimer's disease. The difference between lecanemab and other pharmacological treatments is that the former delays the disease progress, effectively buying time for patients to enjoy their independence longer; whereas the latter works to manage symptoms.

“It doesn't stop disease progression. But what it does is it slows the progression of the disease so that you don't move from an earlier stage of disease to a more advanced stage so quickly” said Dr Chin.

The geriatrician was careful to manage expectations regarding what lecanemab can and cannot do.

“One reason for this is that amyloid is only part of the problem. There's also tau protein, so we are addressing part of the problem, although it’s a very important part of the pathological process. So the goal of treatment with lecanemab is to maintain the patient’s independence and function for as long as possible.”

Eligibility And The Window of Opportunity

One of the most critical aspects of lecanemab is that the treatment is strictly for those in the early stages of Alzheimer’s disease, particularly mild cognitive impairment or mild dementia.

Dr Chin explained that mild cognitive impairment is a stage where Alzheimer’s disease has not yet significantly affected a person’s daily life, while mild dementia is the stage where a person might need help with complex tasks like managing finances or driving, but patients are still largely independent.

"The key criteria for the use of lecanemab in patients with dementia are, firstly, you need to have pathological proof that you have Alzheimer's disease, and secondly, that you are at an early stage of the disease," said Dr Chin.

“The gold standard for the biological diagnosis is an amyloid PET scan, which is currently not available in Malaysia. An alternative is doing a lumbar puncture to look for certain proteins in your cerebrospinal fluid.

“But at the end of last year, what became available was a blood test to test for a blood biomarker called p-tau217, which can also offer biological proof that you have Alzheimer's disease. It is nearly as accurate as an amyloid PET scan.”

Dr Chin further stated that patients will need appropriate assessments to determine their eligibility for lecanemab. This includes an assessment to determine their stage of Alzheimer’s disease by a doctor who has expertise in terms of diagnosing dementia. Assessments include history, physical examination and neuropsychological assessments.

Furthermore, an MRI is necessary to ensure there are no small bleeds or significant stroke-like changes in the brain. A genetic test for the APOE gene is used for risk stratification.

Buying Time: The Value Of Independence

Perhaps the most significant revelation from recent clinical data for lecanemab is the concept of "time gain."

Dr Chin emphasised that the expectation for this drug is not symptom improvement. Simply put, it does not restore memory.

“We want to slow down the progression in terms of the time it takes for patients to change from a mild stage, where patients are independent, to a more severe stage, where patients are dependent and need help with their activities of daily living, and where there are issues in terms of whether or not the patients can be safely left on their own,” he explained.

Recent research also suggested that for certain subgroups, lecanemab can delay progression from early Alzheimer’s to a more advanced stage by up to 8.3 years.

Lecanemab pricing in Malaysia has yet to be determined since the medication by the Japanese pharmaceutical company Eisai was only recently approved by regulators.

Beyond the financial aspect, Dr Chin said medical centres must have the specific expertise to diagnose and stage Alzheimer’s disease accurately, as well as the facilities to provide regular infusions of Lecanemab while monitoring for side effects.

Despite these challenges, Dr Chin viewed the drug as an exciting development. "It is something that changes the goalposts as to how to what we can do for early Alzheimer's disease.”

Alzheimer’s disease in Malaysia is a growing concern. Age is the major risk factor for Alzheimer’s dementia and dementia in general. Therefore, with Malaysia’s fast ageing population, the number of patients in Malaysia with dementing syndromes is expected to hit over 600,000 by the year 2050, he said.

While lecanemab offers newfound hope, Dr Chin stressed that it must be part of a more comprehensive strategy.

“We have good evidence that lifestyle factors are very important and what we do in our daily life such as exercise, a healthy diet, social interaction, good sleep, cognitive stimulating activities, all help to reduce the risk of developing dementia.

“It's also important to optimally manage conditions such as diabetes, hypertension, high cholesterol to reduce your vascular risk. You also have to address conditions such as hearing or visual loss. All these things are part and parcel of reducing risk of progression, regardless of what medication that you use.”

Don’t wait for the window to close—contact SJMC's 24-hour appointment helpline today to find out if your loved one is eligible for Lecanemab treatment.

Source: CodeBlue