Adoption Strategies for Lecanemab in Alzheimer's Disease

A "boot camp" session at the American Academy of Neurology (AAN) annual meeting focused on the logistical challenges of prescribing lecanemab (Leqembi) for Alzheimer's disease, including how to select appropriate patients, handle the frequent clinic visits, and monitor for side effects.

In this exclusive MedPage Today video, Christian Camargo, MD, of the University of Miami Miller School of Medicine, gives an overview of the discussion and encourages fellow practitioners to watch the session in the meeting's on-demand program.

Following is a transcript of his remarks:

There wasn't anything particularly innovative that came out from the sense of groundbreaking studies; I think a lot of those tend to be reserved for the Alzheimer's-specific conferences. However, I think what was done particularly well was more adoption strategies. In terms of adoption strategies, I think what was done well was, for example, getting people to better understand and be better positioned to implement, for example, the monoclonal antibody therapies for Alzheimer's disease, specifically lecanemab, of course, that being the one that was [fully] FDA approved last summer.

And there's a lot of questions that have come up, even locally. People asked me both at the University of Miami and from private institutions around town, and even across the state about not just my thoughts on it, but even if people are going to make the decision to give it, the operational aspects behind it and some concerns.

And I thought they did a very good job of addressing that because, for example, you have to assess candidacy. You have to see if somebody is an appropriate candidate. For example, we're making sure that they actually have Alzheimer's disease at the biomarker level. In other words, that they actually possess the protein amyloid beta that's the principal component responsible for Alzheimer's. So they did a very good job of describing that biomarker definition. They did a very good job. There's a good talk by Gil Rabinovici from University of California San Francisco, who just gave a great overview of that biomarker definition, the imaging data, and explaining how Medicare is now paying for it and covering for it, I don't want to say precisely at a national level, but they're allowing the MCOs [managed care organizations], the local offices, to make that decision. But they do have a national statement saying that it is covered. So what that does is it enables payers, it enables Medicare patients to get this covered and really widens access to it.

So that's why it was so important that this topic was addressed -- who's eligible, what studies would be necessary to determine who's eligible, how to order them, and who would have eligibility for that. So that's that line of thinking.

The other big concern that people have is, of course, the side effects. What could they be? Who's at higher risk? How to test to see who's at higher risk. And again, they discussed that also from not just a theoretical level, which of course we've known that for a while, but again, how to operationalize it too.

So there were quite a few talks about it. And because this is a general neurology conference, and there might be some people who, even though they have a predominance of Alzheimer's patients, tend to do more general practice. I think that was very appropriate that they dedicated quite a few talks to that. So I thought that it was very good that the AAN had quite a few discussions regarding that, even though they weren't, shall we say, innovative in that sense.

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