AAN guidance on early AD treatment focuses on care, collaboration, new therapies

Key takeaways:

• Early Alzheimer’s care should include new FDA-approved therapies like lecanemab.
• The guidance suggests greater collaboration and advocacy between patients, caregivers and clinicians.

New guidance from the American Academy of Neurology on early Alzheimer’s disease treatment calls for greater collaboration from patients, caregivers and clinicians as well as the embrace of new therapeutics.

“Recent data on lecanemab and other monoclonal antibody infusion targeting amyloid-beta protein make clear that new agents are highly likely to be part of the toolkit for clinicians caring for patients with [Alzheimer’s disease],” Vijay K. Ramanan, MD, PhD, lead author and neurologist at the Mayo Clinic in Minnesota, and colleagues wrote in Neurology.

Ramanan and colleagues offered practical guidance for a broad range of neurology clinicians on logistical considerations and decision-making on emerging antiamyloid monoclonal antibodies (mAbs). The recently FDA-approved lecanemab, which demonstrated slowing of cognitive and functional decline in early symptomatic AD through the CLARITY-AD clinical trial, marked its potential as a treatment option for certain patients.

However, the new guidance stipulates careful patient screening for lecanemab prescription, as existing safety and efficacy data exclude those with presymptomatic AD or individuals with moderate to severe dementia.

Further, it is recommended that clinicians, patients and caregivers share a continued communication to properly align expectations as well as to discuss and plan for the goals and risks of care associated with AD.

Ramanan and colleagues also included close monitoring of drug administration and safety considerations as additional keystones of the reconfigured guidance. The approval of drugs such as lecanemab or donanemab, which require IV infusion over 2 and 4 weeks, respectively, compels the shifting of AD care protocol to office visits consistent with updated rules on therapeutic administration to facilitate rapid evaluation in case of acute treatment-related adverse events including amyloid-related imaging abnormalities (ARIA).

Additionally, the introduction of new mAbs will require greater community access to physicians, from primary care through neurology specialists, to achieve these goals. The paper suggests an increase in collaboration among health care professionals, with care-specific evaluations and reimbursable services, along with greater awareness and advocation by patients and caregivers to achieve more detailed and accurate profiles.

“To help neurologists provide the highest quality care, experts with the American Academy of Neurology have summarized the available evidence on anti-amyloid monoclonal antibodies so that neurologists, patients and their caregivers can make informed decisions together about possible treatment with these therapies.” American Academy of Neurology President Carlayne E. Jackson, MD, FAAN, said in a related release.

Reference:

• AAN issues guidance on new treatments for early Alzheimer’s disease. https://www.aan.com/PressRoom/Home/PressRelease/5103. Published July 26, 2023. Accessed July 27, 2023.