Viewpoint’s new article American Medical Association Journal (Japan Automobile Manufacturers Association), titled “Use of Recanemab in Patients with Cardiovascular Disease – Challenging Uncertainty,” is a study to improve decision-making before starting treatment with lecanemab (brand name Rekenbi), an FDA-approved Alzheimer’s disease drug. We advocate additional research.

Dosing with lecanemab and other anti-amyloid monoclonal antibodies (mAbs) that will be approved in the future, according to Darae Koh, MD, MSc, a cardiologist and research fellow at Hebrew Senior Life’s Hinda and Arthur Marcus Institute on Aging, et al. They say advanced care plans need to be developed before they begin. This is important for clinicians, patients, and their families to be fully aware of the unknowns, especially for patients with cardiovascular disease who may require anticoagulants and thrombolytics.

The authors conclude that “in the early stages of drug deployment, patients are carefully selected to minimize the drug’s potential side effects,[but]major safety concerns remain… amyloid-related imaging abnormalities.” (ARIA), and the most common is amyloid-associated imaging abnormalities (ARIA).” “One of them is cerebral microbleeds, and the risk was higher in patients receiving anticoagulant therapy,” Dr. Ko said.

Antithrombotic therapy presents a unique challenge for patients considering some Alzheimer’s disease drugs. In their opinion, the authors note that in approving lecanemab, the FDA did not advise on the risks of concurrent anticoagulation, and that “the Alzheimer’s Association Treatment Working Group took a more conservative approach.” , recommended the use of anticoagulant therapy for patients with cerebral amyloid angiopathy and those currently prescribed anticoagulant therapy. Anticoagulants should not be candidates for lecanemab because the risk of bleeding outweighs the potential benefit. ”

“Three common acute clinical conditions, ischemic stroke, myocardial infarction, and pulmonary embolism, require treatment with thrombolytic and anticoagulant drugs and urgent clinical decisions, so anti-amyloid “We expect this to be particularly difficult in patients treated with mAbs and anti-amyloid antibodies, which will require careful up-front directive conversations with patients,” they wrote in their paper.

Decisions regarding the use of lecanemab, an important advance in the treatment of Alzheimer’s disease, are currently being made based on limited safety data. The authors conclude, “To address this challenge, we need to create multidisciplinary Alzheimer’s disease treatment teams, develop shared decision-making models for advanced treatment planning, and provide the necessary empirical data to guide treatment decisions.” There is an urgent need to create a

Provided by: Hebrew Senior Life Hinda and Arthur Marcus Institute on Aging