Lecanemab-LEQEMBI long-term use recommendations and analysis of discontinuation risks and safety

Lecanemab (lecanemab)-LEQEMBI is a new anti-amyloid beta (Aβ) monoclonal antibody, mainly used for the treatment of patients with early Alzheimer's disease (AD). Its mechanism of action is to slow down neuronal damage and cognitive function decline by selectively binding to large soluble Aβ oligomers and promoting their clearance. The clinical application of lencanezumab focuses on the intervention of early AD patients, especially those in the mild cognitive impairment (MCI) stage or mild AD, in order to delay disease progression and improve patients' quality of life.

In terms of treatment schedule, lencanezumab is usually administered by intravenous infusion, once every two weeks. The specific dose of the initial course of treatment needs to be determined based on the patient's weight and hematological indicators. Magnetic resonance imaging (MRI) evaluation should be performed before infusion to rule out the risk of cerebral microbleeds or vascular lesions. Clinical trials have shown that continued use of the drug for several months to one year can significantly reduce AAβ deposition in the brain, and improve cognitive scores and daily functional assessment results to a certain extent. The treatment course design emphasizes long-term and regular administration to maintain a stable concentration of the drug in the body and a sustained Aβ clearance effect.

Long-term use of lencanezumab requires comprehensive evaluation of patient tolerability and safety. Common adverse events include infusion-related reactions, headache, angioedema (ARIA-E) and cerebral microbleeds (ARIA-H). Cerebrovascular events mostly occur in the early stages of treatment. Therefore, patients need to undergo regular MRI review during long-term treatment and evaluate based on clinical symptoms. For high-risk patients, such as those with a history of cerebrovascular disease or anticoagulant therapy, medication should be used with caution under the guidance of a doctor. Long-term monitoring strategies include blood pressure, liver and kidney function, routine blood tests, and imaging examinations to ensure a balance between efficacy and safety.

The risk of drug discontinuation is also a focus of clinical concern. Studies have shown that sudden discontinuation of lencanezumab may lead to a renewed increase in Aβ deposition in the brain and accelerate the decline of cognitive function. Although there are currently no clear criteria for discontinuation of medication, in clinical practice it is generally recommended to gradually adjust or extend the dosing interval after evaluation under the guidance of a physician, rather than to discontinue medication completely suddenly. Cognitive function, daily living activities, and brain imaging changes should be fully assessed before discontinuation of medication to reduce the risk of rapid disease progression.

In addition, the safety of lencanezumab in combination treatment strategies also needs attention. Some patients may also receive other AD related drugs, such as cholinesterase inhibitors or NMDA Receptor antagonists, please pay attention to drug interactions and compound adverse events when used in combination. Clinical experience shows that combined use is feasible under strict monitoring, but careful assessment of the patient's overall condition, vascular risk, and medication compliance is still required.

For patients and their families, long-term treatment compliance is critical. Since lencanezumab is administered by intravenous infusion once every two weeks, you need to go to a medical institution regularly to receive infusions and cooperate with MRI review and cognitive assessment. Home care and lifestyle interventions can also help slow the progression of the disease, such as cognitive training, regular sleep and rest routines, and nutritional management. Through standardized management, drug efficacy can be maximized, the risk of adverse events can be reduced, and patients' quality of daily life can be improved.

In general, lecanemab (lecanemab)-LEQEMBIas early stageAD’s targeted therapy drugs are mainly administered intravenously once every two weeks, emphasizing long-term and regular administration to maintain Aβ clearance and improvement of cognitive function. Long-term use requires close monitoring of brain imaging and hematology indicators to ensure safety. The risk of discontinuation suggests that caution should be exercised to avoid rapid decline in cognitive function. At the same time, patients should carry out individualized dose adjustment and treatment course management under the guidance of doctors, combined with lifestyle intervention and home care, in order to obtain the best efficacy and safety in clinical practice.

Reference materials:https://pmc.ncbi.nlm.nih.gov/articles/PMC11418606/