To assess patient outcomes after starting lecanemab (Leqembi) treatment.  

Leqembi is an FDA-approved monoclonal antibody for the treatment of early Alzheimer’s disease.

A committee of 5 neurologists practicing at the NYU Langone Pearl Barlow Center for Memory Evaluation & Treatment was established to review all patients recommended for Leqembi therapy within the NYU Langone Healthcare system. This committee, similar to a cancer center tumor board, met regularly and unanimous approval after discussion of each patient was required before starting therapy. Patients were required to have a diagnosis of Alzheimer’s disease confirmed by CSF or Amyvid PET, MMSE>20, CDR=0.5-1, Apolipoprotein E genotyping, <4 microhemorrhages on MRI, and neither taking anticoagulants or immunomodulatory medications nor have active cancer. MRI was performed prior to the 5th, 7th, and 14th infusions.

Baseline CDR mean was 0.73 and MMSE mean was 24.13. CDR scores were 0.70+/-0.27 (p=0.03) at 3 months, 0.72+/-0.25 (p=0.05) at 6 months, and 0.85+/-0.24 (p=0.08) at 9 months. Change in CDR from baseline was minimal through 9 months. Mean MMSE at 3 months was 24.4+/-3.23 (p=0.077), 23.4+/-3.91 (p=0.067) at 6 months, and 21.65+/-3.69 (p=0.003) at 9 months. ARIA-E and ARIA-H were seen in 4 (1 e4/e4) and 8 (3 e3/e4, 3 e4/e4) patients, respectively, at 3 months, 3 (1 e3/e4) and 11 (6 e3/e4, 4 e4/e4) at 6 months, and 0 and 6 (2 e3/e4, 2 e4/e4) at 9 months. Eight patients discontinued therapy. No deaths were attributed to Leqembi.

The majority of patients’ cognitive decline is quite slow over the first 9 months of Leqembi therapy and consistent with rates observed in CLARITY AD.  Institution of a review committee provided a means to standardize approach to patient selection.