The University of Washington’s Memory and Brain Wellness Center at Harborview Medical Center has begun treating patients with donanemab, a new Alzheimer’s medication that may slow cognitive decline in people with early-stage disease, according to UW Medicine.
The drug joins lecanemab, another Alzheimer’s treatment that the center began offering in late 2023. Both drugs are monoclonal antibodies designed to help the immune system clear amyloid plaques — the sticky protein clumps associated with Alzheimer’s-related brain damage — from the brain.
“While we don’t know whether donanemab or lecanemab can arrest Alzheimer’s, they do appear to help people with mild cognitive impairment and extend the time they are independent and able to manage their daily lives,” said Dr. Thomas Grabowski, medical director of the Memory and Brain Wellness Center and professor of radiology and neurology at the UW School of Medicine.
Unlike lecanemab, which is given via IV every two weeks, donanemab is administered monthly. That schedule can make it more convenient for patients traveling long distances.
“For people coming to us for treatment from Eastern Washington, Montana, Idaho and the Olympic Peninsula, that donanemab has to be given only once a month is a big advantage,” said Dr. Michael Rosenbloom, associate professor of neurology at UW and clinical trials director at the center.
Clinical trials also suggest that donanemab may not require lifelong treatment. Once amyloid plaques are cleared, patients may still experience benefits even if the drug is discontinued, Rosenbloom said.
However, the drugs are not a cure and do not reverse memory loss. They are only approved for people with mild cognitive impairment or mild dementia related to Alzheimer’s. Patients must also show evidence of amyloid buildup in the brain, which can be confirmed through specialized brain scans or tests of spinal fluid or blood.
One potential risk with both medications is amyloid-related imaging abnormalities, or ARIA — a condition involving fluid leakage in the brain that can lead to swelling or small bleeds. ARIA is typically detected on MRI scans and may not cause symptoms, but treatment is paused if abnormalities are found until scans return to normal. In more severe cases, treatment is stopped completely.
Patients are regularly monitored with MRI scans during treatment to screen for ARIA. People with a genetic risk factor — carrying one or two copies of the ApoE epsilon 4 gene — are more susceptible to developing ARIA while on donanemab. These patients will be screened to assess their risk. In cases where a patient carries two copies of the gene, lecanemab may be recommended instead.
Rosenbloom emphasized that early detection is crucial, as the drugs are only effective in the early stages of the disease. “It is important for people who experience cognitive problems to consult their primary-care providers for evaluation,” he said. “If their cognitive problems stem from Alzheimer’s, the medications may be started early, when they are most likely to have benefit.”
Treatment with donanemab and lecanemab is covered by Medicare.
Private insurance coverage varies by provider and plan. Patients and families are encouraged to speak with their primary-care doctor or neurologist to learn more.
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