People celebrated when lecanemab got an important clearance from the U.S. Food and Drug Administration in July. Staff at the Norton Neuroscience Institute Memory Center in Louisville already had been laying the groundwork so they could quickly start providing the new treatment.
One of their first patients is Ann Bruce, a lifelong Louisvillian. She recently started receiving lecanemab, which is given through intravenous infusions every two weeks.
She said the team at the Norton Neuroscience Institute Memory Center has been wonderful.
“They're welcoming. They get you comfortable,” she said. “I'm not big on shots or anything like that. But the infusion is a simple needle that goes into your arm. And I will tell you, I haven't even squinted.”
People are still researching what causes Alzheimer’s. A leading hypothesis points to the accumulation of a specific protein, known as beta-amyloid, in the brain. And lecanemab is designed to remove those proteins.
“Its job is to break up the amyloids. After my first treatment, my daughter and I were driving home and we started making up songs about … how to get rid of amyloid,” Bruce said, chuckling, as she sat in her home one recent morning.
Dr. Greg Cooper is the director of the Norton’s Memory Center. He said Norton is one of the first places in the country to begin providing lecanemab.
“It's been enormously gratifying as we see people start this treatment,” he said. “They know that we're not curing the disease. But there's still a lot of hope and excitement that we're slowing this down, we're helping them preserve what they have.”
Cooper said his team has set up processes to safely administer lecanemab.
First, medical staff evaluate prospective patients to see if they’re eligible candidates for the medication. Lecanemab is targeted toward people in the early stages of Alzheimer’s who have mild cognitive impairment.
Cooper said the Norton team screens patients to see if they have elevated levels of amyloid in their brain. And the team runs other tests to see if they have a high risk of experiencing complications from the medication.
Another issue medical providers and patients have to navigate is financing. Depending on the health insurance plan, Cooper said lecanemab treatments can cost a patient anywhere between zero dollars and $500 per month.
He said they’ve already seen denials for coverage by insurance, and Norton team members are exploring how to limit those denials.
If a patient is cleared for treatment, they start lecanemab infusions. The patient also gets periodic MRI scans to see if there’s any swelling or bleeding in the brain, which are serious possible side effects.
Because of those potential complications, administering lecanemab requires “a great deal of planning and precaution,” said Dr. Greg Jicha, a professor of neurology at the University of Kentucky.
“It really is a therapy that requires some degree of expertise, confidence — and most importantly — the system set up to ensure patient safety as well as access,” he said.
UK’s Sanders-Brown Center on Aging has done clinical trial work on lecanemab. Now that the medication has full federal approval, the center is scheduled to start providing lecanemab treatments the first week of December.
Jicha said the center has screened well over 100 patients so far. But he estimates thousands more Kentuckians will be eligible candidates.
That’s why he wants to eventually see institutions like UK and Norton work with other health care providers to expand access to this breakthrough treatment.
“This infusion therapy requires visits every two weeks,” he said. “And if people have to drive to Louisville and Lexington, it's going to be prohibitive for the breadth of our state and the many folks in rural areas. … Not everybody's going to be able to walk through the door all at once. It's going to be a process of figuring out how we bring these folks in and how we bring them in safely.”
Cooper, of the Norton Memory Center, said how long a patient should receive lecanemab, over the long term, is an open question.
In the field of Alzheimer’s treatment, this is new territory.
Likewise, Bruce doesn’t know for sure how the lecanemab infusions will affect her long-term prognosis. But she’s excited she’s able to try the medication.
She said she’s taking it easy and “looking forward to whatever life I have … given back to me.”
“Look, I'm 76 years old,” she said. “I've got a lot of energy left in my old body, and I'm ready to go as long as the Lord is willing.”
