Kuala Lumpur, Malaysia – A newly approved Alzheimer’s drug, lecanemab, offers a potential turning point in the fight against the debilitating disease, with early data suggesting it may slow cognitive decline by more than eight years in some patients. The immunotherapy, recently granted full approval by the National Pharmaceutical Regulatory Agency (NPRA) in Malaysia, represents a shift from simply managing symptoms to actively modifying the disease’s progression. Subang Jaya Medical Centre (SJMC) became the first facility in the country to administer the medication, offering a new avenue of hope for individuals in the early stages of Alzheimer’s.
Alzheimer’s disease, the most common form of dementia, affects millions worldwide, progressively eroding memory, thinking skills, and behavior. Until recently, treatments focused on alleviating symptoms, providing temporary relief without addressing the underlying pathology. Lecanemab, however, targets the disease process itself, aiming to preserve cognitive function and independence for a longer period. The potential impact on quality of life for both patients and their families is significant, particularly as Malaysia’s population ages and the prevalence of dementia is projected to rise.
Dr. Chin Ai-Vyrn, a consultant geriatrician and internal medicine physician at SJMC, who was the first in Malaysia to administer lecanemab, explains the drug’s mechanism. “Lecanemab is a very promising advance in the treatment of Alzheimer’s disease,” she said. “The evidence from clinical trials and real-world studies shows that lecanemab changes the trajectory and slows the progression of Alzheimer’s disease. By doing so, it helps patients with early symptomatic Alzheimer’s disease remain independent for longer.” The drug received initial approval from the United States’ Food and Drug Administration (FDA) in January 2023, paving the way for its availability in other countries.
Understanding the Science Behind Lecanemab
At the heart of Alzheimer’s disease lies the abnormal buildup of proteins in the brain. The process begins with the accumulation of amyloid plaques, followed by the formation of tau tangles. These protein deposits disrupt brain cell function, ultimately leading to cognitive decline. Lecanemab, a humanized IgG1 monoclonal antibody, is designed to target and remove amyloid plaques.
“Lecanemab is an antibody that targets amyloid,” Dr. Chin explained. “It’s given through the bloodstream and passes the blood-brain barrier into the brain. It then binds to the amyloid protein, and this stimulates our immune system to then remove this protein from the brain itself. So it gets rid of this protein, the amyloid protein from the brain.” While not a cure, lecanemab aims to slow the disease’s progression, effectively “buying time” for patients to maintain their independence and quality of life. It’s important to note, however, that amyloid is only one piece of the puzzle. tau protein also plays a critical role in the disease process.
Who is Eligible for Lecanemab Treatment?
Lecanemab is specifically approved for individuals in the early stages of Alzheimer’s disease, encompassing those with mild cognitive impairment (MCI) or mild dementia. MCI represents a transitional stage where cognitive changes are noticeable but don’t significantly interfere with daily life. Mild dementia involves more pronounced cognitive difficulties, potentially requiring assistance with complex tasks like financial management or driving, but individuals generally remain largely independent.
Confirming a diagnosis of Alzheimer’s disease and determining eligibility for lecanemab requires a comprehensive evaluation. Traditionally, the “gold standard” for biological diagnosis has been an amyloid PET scan, which visualizes amyloid plaques in the brain. However, amyloid PET scans are currently unavailable in Malaysia. An alternative involves a lumbar puncture to analyze cerebrospinal fluid for specific proteins. More recently, a blood test measuring the p-tau217 biomarker has emerged as a highly accurate method for detecting Alzheimer’s pathology, offering a less invasive diagnostic option. According to a study presented at the Clinical Trials on Alzheimer’s Disease (CTAD) meeting, this biomarker is nearly as accurate as an amyloid PET scan.
Beyond biomarker confirmation, a thorough assessment of a patient’s cognitive function, medical history, and brain health is essential. This includes neuropsychological testing, MRI scans to rule out other potential causes of cognitive impairment, and genetic testing to assess risk factors like the APOE gene.
The Promise of “Time Gain” and Future Considerations
Recent research, including data presented at CTAD, suggests that lecanemab can delay the progression from early Alzheimer’s to a more advanced stage by up to 8.3 years for certain subgroups of patients. BioArctic reported these findings, highlighting the potential for significant clinical benefit. Dr. Chin emphasizes that the primary goal of lecanemab is not to restore lost memory but to slow the rate of decline, preserving independence and function for as long as possible.
The cost of lecanemab in Malaysia has not yet been determined, as the medication was only recently approved by regulators. Administering the drug requires specialized medical centers with expertise in Alzheimer’s diagnosis and staging, as well as the infrastructure to provide regular infusions and monitor for potential side effects. Despite these challenges, Dr. Chin views the drug as a significant step forward. “It is something that changes the goalposts as to how to what we can do for early Alzheimer’s disease.”
With Malaysia’s rapidly aging population, the number of individuals affected by dementia is expected to exceed 600,000 by 2050. While lecanemab offers a new treatment option, Dr. Chin stresses the importance of a comprehensive approach to dementia prevention and management. “We have good evidence that lifestyle factors are very important and what we do in our daily life such as exercise, a healthy diet, social interaction, good sleep, cognitive stimulating activities, all help to reduce the risk of developing dementia. It’s also important to optimally manage conditions such as diabetes, hypertension, high cholesterol to reduce your vascular risk. You also have to address conditions such as hearing or visual loss. All these things are part and parcel of reducing risk of progression, regardless of what medication that you use.”
The availability of lecanemab in Malaysia marks a significant advancement in Alzheimer’s care. The next step will be establishing clear guidelines for patient selection, ensuring equitable access to treatment, and continuing to monitor long-term outcomes. Further research is also needed to explore the potential of combination therapies and identify new strategies for preventing and treating this devastating disease.
Disclaimer: This article provides information for general knowledge and informational purposes only, and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
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