Is it time for geriatricians to get on board with lecanemab? Jason Karlawish and Ken Covinsky
We\u2019ve talked at length on prior podcasts about the failures of aducnumab, Biogen, and the FDA\u2019s decision to approve it.\xa0\xa0
But wait, there\u2019s a shiny new anti-amyloid drug, lecanemab!\xa0 (No it\u2019s not just the French version of Aducanumab).\xa0\xa0
In an article in the NEJM (a published article this time, wonder of wonders!) lecanemab was shown to slow the rate of cognitive decline by 0.45 points on an 18 point cognitive scale compared to placebo.\xa0 Wow!\xa0 Wow?\xa0 Wait, what?\xa0\xa0
On today\u2019s podcast we talk with Jason Karlawish, who we\u2019ve had on previously talking about his book The Problem of Alzheimer\u2019s and with Aaron Kesselhim, to discuss FDA approval of Aducanumab, as well as frequent guest and host Ken Covinsky.\xa0\xa0
They debate today\u2019s central question: is it time for geriatricians to get on board with lecanemab?\xa0 Along the way we address:
- Is this degree of slowed cognitive decline meaningful to patients or care partners?
- What about the burdens, risks, and harms? Every 2 week visits for infusions, regular monitoring for brain swelling and bleeding, case report level risk of death?
- Did the study do enough to address issues of inclusion and diversity by age, race and ethnicity, and multimorbidity?
- What does this study say about the amyloid hypothesis?
- Should the FDA approve, and under what conditions?
Their answers may surprise you.\xa0\xa0
As a preview of final thoughts at the end of the episode, Ken and Jason agree that the FDA should approve lecanemab conditional on a post-approval monitoring system and public access to study data, geriatricians should be prepared to have thoughtful conversations with patients about the risks and benefits of lecanemab in view of their values and priorities, and ultimately, that geriatricians should be open to prescribing it.\xa0
Wow!
The times, they are a changin.
-@AlexSmithMD\xa0