Anvisa approves lecanemabe for early-stage Alzheimer's treatment

Brazil's National Health Surveillance Agency (Anvisa) approved the drug lecanemabe, marketed as Leqembi, on Thursday, January 8, for patients with early-stage Alzheimer's. The monoclonal antibody, administered via infusion, slows disease progression in individuals with mild cognitive impairment and confirmed beta-amyloid protein in the brain. The approval marks progress, though it is not a cure.

Brazil's National Health Surveillance Agency (Anvisa) announced the approval of lecanemabe, an innovative monoclonal antibody for treating early-stage Alzheimer's disease. Indicated for patients with mild dementia and cognitive impairment, the drug requires confirmation of beta-amyloid plaques in the brain, linked to the neurodegenerative condition.

The approval study involved 1,795 participants in the disease's early stage. Comparing the lecanemabe-treated group to a placebo, efficacy was assessed using the CDR-SB scale, which measures symptom severity and daily life impact after 18 months. Administration is via one-hour intravenous infusions every two weeks.

Similar to donanemabe (Kisunla), approved by Anvisa in April last year, lecanemabe does not cure the disease but slows its progression by targeting sticky structures that damage neurons. "The approval of this medication offers a new treatment option for people with early-stage Alzheimer's," says neurologist Paulo Caramelli, a professor at UFMG. He notes that it scientifically validates amyloid protein as a therapeutic target.

Restrictions limit use to initial stages, with no or one copy of the ApoE ε4 gene, and exclude advanced-stage patients or those with contraindications like anticoagulant use. Risks include ARIA, abnormalities such as brain swelling or bleeding, requiring strict screening and monitoring with MRI. Caramelli stresses the need for specialized teams: "Follow-up requires periodic complementary exams, mainly MRI."

Previously, treatments only managed symptoms; now, options like this slow cognitive and functional decline, preserving independence longer.

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Clinical illustration of nurse giving single-dose zilebesiran injection to hypertension patient, with blood pressure monitor showing reduction from KARDIA-2 trial results.
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Single-dose zilebesiran as add-on therapy lowers systolic blood pressure in KARDIA-2 trial

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A single, under-the-skin dose of the investigational RNA-interference drug zilebesiran lowered blood pressure when added to standard therapy in adults whose hypertension remained uncontrolled, according to results from the global Phase 2 KARDIA-2 trial of 663 participants published in JAMA.

A team of researchers led by Professor Yan-Jiang Wang has published a review arguing that Alzheimer's disease requires integrated treatments targeting multiple factors, not single causes. New drugs like lecanemab and donanemab offer modest benefits by slowing decline, but fall short of reversal. The paper, in Science China Life Sciences, emphasizes genetics, aging, and systemic health alongside amyloid-beta and tau proteins.

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A major Cochrane review of 17 clinical trials involving over 20,000 participants has concluded that drugs targeting amyloid beta in the brain provide no meaningful benefits for patients with mild cognitive impairment or early Alzheimer’s. These treatments also raise the risk of brain swelling and bleeding. Researchers urge a shift to alternative pathways for future treatments.

Researchers at Cold Spring Harbor Laboratory have found that blocking the protein PTP1B improves memory and boosts plaque clearance in mouse models of Alzheimer's disease. The discovery links the protein to brain immune function and metabolic risks like diabetes and obesity. The team aims to develop inhibitors for potential human treatments.

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Researchers at the Perelman School of Medicine at the University of Pennsylvania report that a protein called glycoprotein nonmetastatic melanoma B (GPNMB) may help drive the cell-to-cell spread of Parkinson’s-related alpha-synuclein pathology in lab models. In cultured-neuron experiments, antibodies designed to block GPNMB reduced the propagation of the toxic process, according to a study the team says was published in Neuron.

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