Leqembi® (lecanemab) launched in the EU today
Following the EC approval, Eisai has been collaborating with the regional and local healthcare authorities to implement the mandatory authorisation requirements ahead of launch. The required controlled access program[2] is now in place in
Alzheimer's disease is a progressive, relentless disease with Aβ and tau as hallmarks. It progresses in stages that increase in severity over time, and each stage of the disease presents different challenges for those living with the disease and their care partners. There is a significant unmet need for new treatment options that slow the progression of Alzheimer's disease from its early stage and reduce the overall burden on people affected by Alzheimer's disease and society. Only Leqembi fights Alzheimer's disease in two ways - targeting both amyloid plaque and protofibrils[3], which can impact tau accumulation downstream.
In the Clarity AD clinical trial, the primary endpoint was the global cognitive and functional scale, Clinical Dementia Rating – Sum of Boxes (CDR-SB).i Treatment with lecanemab (n=757), in the EU indicated population (ApoE ε4 non-carriers or heterozygotes, measured by controlled-based multiple imputation[4]), reduced clinical decline on CDR-SB by 31% at 18 months compared to placebo (n=764).i
In the EU indicated population (ApoE ε4 non-carriers or heterozygotes) (n=757), the most common adverse reactions were infusion-related reaction (26%), ARIA-H (13%), headache (11%) and ARIA-E (9%). Symptomatic ARIA-E occurred in 2% of participants. Symptomatic ARIA-H occurred in 0.8% of patients.i
Leqembi is the result of a long-standing collaboration between
The information was released for public disclosure, through the agency of the contact person below, on
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About lecanemab (Leqembi®)
Lecanemab is the result of a strategic research alliance between
Lecanemab is approved in the
The primary endpoint was the global cognitive and functional scale, CDR-SB ii In the Clarity AD clinical trial, treatment with lecanemab (n=757), in the EU indicated population (ApoE ε4 non-carriers or heterozygotes, measured by control-based multiple imputation), reduced clinical decline on CDR-SB by 31% at 18 months compared to placebo (n=764).i The mean CDR-SB score at baseline was approximately 3.2 in both groups.i The adjusted least-squares mean change from baseline at 18 months was 1.217 with lecanemab and 1.752 with placebo (difference, −0.535; 95% confidence interval [CI], −0.778 to −0.293).1 CDR-SB is a global cognitive and functional scale that measures six domains of functioning, including memory, orientation, judgement and problem solving, community affairs, home and hobbies, and personal care.[iii]
In addition, the secondary endpoint from the AD Cooperative Study-Activities of Daily Living Scale for Mild Cognitive Impairment (ADCS MCI-ADL), which measures information provided by people caring for patients with AD, noted 33% less decline compared to placebo at 18 months.i The adjusted mean change from baseline at 18 months in the ADCS MCI-ADL score was −3.873 in the lecanemab group and −5.809 in the placebo group (difference, 1.936; 95% CI, 1.029 to 2.844).i The ADCS MCI-ADL assesses the ability of patients to function independently, including being able to dress, feed themselves and participate in community activities.[iv] Amyloid Positron Emission Tomography (PET) using Centiloids and ADAS-Cog14 also showed highly statistically significant results compared with placebo (P<0.001).i
In the EU indicated population (ApoE ε4 heterozygotes or non-carriers), the most common adverse reactions were infusion-related reaction (26%), ARIA-H (13%), headache (11%) and ARIA-E (9%). Symptomatic ARIA-E occurred in 2% of participants. Symptomatic ARIA-H occurred in 0.8% of patients.i
Lecanemab has been approved in 48 countries and is under regulatory review in 10 countries. In
Since
About the collaboration between
Since 2005,
About
[1] Apolipoprotein E is a protein involved in the metabolism of lipid in humans. It is implicated in AD. People with only one (heterozygous) or no copy (non-carriers) of the ApoE ε4 gene are less likely to experience ARIA than people with two ApoE ε4 copies (homozygous).ii ARIA is a recognized important side effect with lecanemab that involves swelling and potential bleeding in the brain.i, ii
[2] Controlled access program is a system that restricts the use and distribution of certain medicines. It is designed to promote the appropriate use of medicines while ensuring patient safety. In line with the EC approval requirements, initiation of lecanemab treatment should be through a central registration system implemented as part of CAP.
[3] Protofibrils are believed to contribute to the brain injury that occurs with AD and are considered to be the most toxic form of Aβ, having a primary role in the cognitive decline associated with this progressive, debilitating condition.v Protofibrils cause injury to neurons in the brain, which in turn, can negatively impact cognitive function via multiple mechanisms, not only increasing the development of insoluble Aβ plaques but also increasing direct damage to brain cell membranes and the connections that transmit signals between nerve cells or nerve cells and other cells. It is believed the reduction of protofibrils may prevent the progression of AD by reducing damage to neurons in the brain and cognitive dysfunction. v, Vi
[4] As requested by the regulatory authority, efficacy analyses were conducted for ApoE ε4 non-carriers or heterozygotes participants using control-based multiple imputation method, in which all missing values were imputed with copy-increments (change between visits) using the actual value in placebo group.vii This methodology differs from that used in the Clarity AD primary analysis which used mixed-model repeat measures (MMRM) with missing at random assumption.
[i] European Medicines Agency Summary of Product Characteristics (SmPC)
[ii] van Dyck, C.H., et al. Lecanemab in Early Alzheimer's Disease.
[iii] Morris, J.C. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology. 1993;43:2412-2414.
[iv] Pedrosa, H., et al. Functional evaluation distinguishes MCI patients from healthy elderly people–the ADCS/MCI/ADL scale.
v Amin, L., Harris, D.A. Aβ receptors specifically recognize molecular features displayed by fibril ends and neurotoxic oligomers.
vi Ono K, Tsuji M. Protofibrils of Amyloid-β are Important Targets of a Disease-Modifying Approach for Alzheimer's Disease. Int J Mol Sci. 2020;21(3):952. doi: 10.3390/ijms21030952. PMID: 32023927; PMCID: PMC7037706.
vii Froelich L., et al. Lecanemab for treatment of individuals with early Alzheimer's disease (AD) who are apolipoprotein E E4 (ApoE e4) non-carriers of heterozygotes. Poster presented at
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