ce CONTINUING EDUCATION patients may notice headache, worsening confusion, dizziness, vision problems, nausea, gait abnormal- ities, and seizures. A baseline magnetic resonance imaging (MRI) scan should be performed prior to initiating lecanemab-irmb, and should be obtained prior to the 5th, 7th, and 14th infusions. If a patient experiences symptoms suggestive of ARIA, clini- cal evaluation should be performed, including an MRI if indicated. Concomitant use of antithrombotic medications (i.e. aspirin, antiplatelets, and anticoag- ulants) should be avoided. Lecanemab-irmb should not be used during pregnancy.
demonstrate substantial improvement over available therapy. Lecanemab-irmb received fast track, prior- ity review, and breakthrough therapy designations and received accelerated approval. 5 It is an intravenous (IV) injection approved for the treatment of Alzheimer’s disease (AD). AD is a pro- gressive neurologic disorder that is characterized pathophysiologically by the presence of bundles of protein comprised of beta-amyloid plaques and tau tangles that damage the brain over time. It is the most common cause of dementia. Lecanemab-irmb is a recombinant humanized immunoglobulin gamma 1 (IgG1) monoclonal antibody directed against aggregated soluble and insoluble forms of beta-am- yloid and thus reduces the buildup of these protein bundles. Administration: Lecanemab-irmb should only be initiated in patients with mild cognitive impairment or the mild dementia form of the disease, which is the population studied in clinical trials. The recom- mended dosage is 10 mg/kg. It must be diluted prior to administration as an IV infusion over approxi- mately one hour, once every two weeks. Safety: The most common adverse events asso- ciated with lecanemab-irmb are infusion-related reactions and headache. Pre-dosing with antihis- tamines, non-steroidal anti-inflammatory drugs (NSAIDS), or corticosteroids can reduce the inci- dence of these reactions. There is a boxed warning for amyloid-related imaging abnormalities (ARIA), which can present as microhemorrhages or edema in the brain. ARIA usually goes away over time and there are usually no symptoms; however, some
How Supplied: Lecanemab-irmb is available as a preservative-free, sterile, clear to opalescent and colorless to pale yellow solution and is supplied in single-dose vials. The unopened vial should be stored in the refrigerator at 2°C to 8°C (36°F to 46°F). It should be stored in the original carton to protect from light. Do not freeze or shake. Additional Notes: Approximately 15% of AD patients have a gene called APoE4 that may increase the risk of ARIA, including symptomatic and serious ARIA. Genetic testing for ApoE4 status should be performed prior to initiation of treatment to inform the risk of developing ARIA. Patients should be informed of the implications of genetic testing and their treatment. Zavzpret (zavegepant) 10
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