UCLA Amyloid Immunotherapy Care

The UCLA Amyloid Immunotherapy Care (AIC) Program is dedicated to the treatment of early Alzheimer’s disease using newly approved anti-amyloid immunotherapies. These new drugs target the removal of brain amyloid-beta plaques that are characteristic features of Alzheimer's disease and are thought to contribute to the progression of the condition. Patients with mild cognitive impairment and Alzheimer’s disease are eligible for treatment. Referrals to the UCLA Amyloid Immunotherapy Care Program come from the UCLA Integrated Memory Clinic. The program adopts a multidisciplinary approach to care that includes behavioral neurology experts, neuroradiology, nuclear medicine, and a team of advanced practitioners, nursing staff, and administrative experts. Interested patients should ask their doctor for a referral to the UCLA Integrated Memory Clinic at (310) 794-1195 to initiate the process of determining eligibility for amyloid immunotherapy. 

Key aspects of the program include:

  1. Prompt Delivery of Care: Program staff will work with patients and caregivers to arrange for clinic visits, diagnostic studies, therapy evaluation, insurance authorizations and other steps required to administer treatments. Once treatment begins, the program is backed by 24/7 availability of a neurologist for unexpected side effects or concerns. 
  2. Research and Development: The program emphasizes creating and refining the process for delivery of amyloid immunotherapies. Beyond receiving treatment, participants in the program will be asked to engage in research to understand various aspects of these therapies including how the brain responds, when to stop the treatments, and the equitable administration of treatment to all those eligible. 
  3. Collaboration: The program collaborates with other UC Health Systems, research institutions, pharmaceutical companies, and academic centers to advance the science behind amyloid-targeted therapies and ensure the development of effective treatments.
  4. Personalized Medicine: This program is an example of the delivery of modern precision medicine with a focus on personalized approaches to treatment, considering individual differences in genetics, disease progression, and response to therapy.

Overall, the UCLA Amyloid Immunotherapy Care Program aims to provide new, potentially effective treatments for Alzheimer’s disease by targeting its underlying pathology with cutting-edge immunotherapy strategies. Lecanemab (Leqembi®) and donanemab (Kisunla™) are both investigational monoclonal antibodies aimed at treating Alzheimer’s disease by targeting amyloid-beta, a protein that accumulates in the brains of patients with the condition. Below are details about each of these treatments. 

Lecanemab (Leqembi®)

The most common side effects are infusion-related reactions (26% vs. 7% in placebo group), bleeding in the brain or brain lining (17% vs. 9% in placebo group), and brain swelling (13% vs. 2% in placebo group). Adverse effects are more common in Alzheimer’s patients who carry the APOE ε4 (APOE4) gene.

  1. Mechanism of Action: Lecanemab targets soluble amyloid-beta protofibrils, which are precursors to amyloid plaques. By binding to these protofibrils, lecanemab helps promote their removal and reduce plaque formation in the brain.
  2. Clinical Trials: In clinical trials, particularly the Phase 3 CLARITY AD trial, lecanemab has shown efficacy in reducing amyloid plaques and has been associated with slowing cognitive decline in patients with early Alzheimer’s disease.
  3. Approval Status: Lecanemab received conditional FDA approval on July 6th, 2023, with ongoing evaluations of its long-term effectiveness and safety.
  4. Administration and Side Effects: It is administered via intravenous infusion every two weeks. Common side effects include infusion-related reactions and amyloid-related imaging abnormalities (ARIA), such as ARIA-edema (swelling) and ARIA-hemorrhage (bleeding).

Donanemab (Kisunla™)

  1. Mechanism of Action: Donanemab targets a specific form of amyloid-beta known as N3pG, which is a modified version found in plaques. By binding to this form, donanemab helps clear amyloid plaques from the brain.
  2. Clinical Trials: In the Phase 3 TRAILBLAZER-ALZ trial, donanemab demonstrated its ability to reduce amyloid plaques and showed potential in slowing cognitive decline in patients with early symptomatic Alzheimer’s disease.
  3. Approval Status: Donanemab is still under evaluation and has not yet received full approval, although it is being closely monitored in ongoing studies.
  4. Administration and Side Effects: Like lecanemab, donanemab is administered through intravenous infusion. Side effects include infusion reactions and ARIA, with similar concerns about ARIA-edema and ARIA-hemorrhage.

 

Both lecanemab and donanemab represent significant advancements in Alzheimer's treatment, targeting amyloid-beta plaques to slow disease progression and improve patient outcomes. You can read and view more details about the benefits and risks of each of these treatments in these recent UCLA Mary S. Easton Center Newsletters. Their continued development and evaluation are critical for understanding their long-term benefits and safety profiles. 

The UCLA Amyloid Immunotherapy Care Program stands at the forefront of Alzheimer’s disease care, aiming to transform the landscape of treatment for this challenging and debilitating disease. By focusing on innovative approaches to target amyloid-beta plaques, the program is dedicated to advancing the development of effective immunotherapies that could potentially slow or halt disease progression. Through CI-CARE principles, rigorous research, clinical trials, and collaborative efforts, UCLA is committed to translating cutting-edge science into tangible benefits for patients, offering hope for a future where Alzheimer's disease can be managed more effectively and its impact on individuals and families significantly reduced.