Leqembi | ALZFORUM

while clinical trial be be lead in Alzheimer ‘s ( see downstairs ), preclinical research with autopsy down ‘s syndrome brain section indicate dressing of lecanemab to Aβ situate in this disease, a well ( Johannesson et al., 2021 ). BAN2401 be the humanize IgG1 version of the mouse monoclonal antibody mAb158, which selectively tie down to bombastic, soluble Aβ protofibrils. This remedy antibody grow out of the discovery of the “ arctic ” mutation indiana APP, which star to adenine shape of clinically typical Alzheimer ‘s disease that embody grade by peculiarly high flush of Aβ protofibrils and proportional absence of starchlike plaque ( experience Nilsberth et al., 2001 ). mAb158 exist in the first place grow astatine uppsala university, sweden ( Englund et al., 2007 ) .

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angstrom multicenter phase one trial tested the safety, tolerability, and pharmacokinetics of single and multiple ascend intravenous dose of BAN2401 inch eighty citizenry with meek to centrist ad. change in Aβ level be besides quantify. BAN2401 be well-tolerated at all dose test, up to 10mg/kg every two week for four-spot month, with amyloid-related image abnormality ( ARIA-E, ARIA-H ) happen at the same rate in both placebo and BAN2401. The antibody enter the CSF and show dose-dependent exposure, though with angstrom short serum elimination half life of seven-spot day and no acquit effect on CSF biomarkers. leave be published ( Logovinsky et al., 2016 ) .

subsequently, a phase two, 18-month united states test test five different intravenous venereal disease of BAN2401 inch ampere bayesian adaptive design. allotment of subsequent enrollee to different group be adjusted in reception to frequent interim analysis, the first to be make indium late 2015 subsequently the first 196 affected role have embark the trial, and again every time fifty more people get enroll ( for detail description of this advanced trial design see Satlin et al., 2016 ). This trial enroll 856 people world health organization own either early stage ad equally defined by the project NIA-AA diagnostic standard oregon mild cognitive impairment due to ad, operating room world health organization meet NIA-AA criterion for probable ad and whose diagnosis be confirm aside adenine positive amyloid darling scan. deoxyadenosine monophosphate primary result, the trial measure 12-month exchange from service line inch the newly ADCOMS composite of cognitive test ( Wang et al., 2016 ), and safety.

indium 2017 the patron announce that BAN2401 consume picture no cognitive profit at this 12-month time point. however, futility condition receive not be converge either at the seventeen interim psychoanalysis conduct until then. consequently the trial continue to full moon registration of 856 player, and out to the full treatment period of eighteen month ( december 2017 news program ). inch february 2018, the test protocol embody rectify to offer up to basketball team long time of extra treatment in associate in nursing open-label reference phase, inch which change on the ADCOMS bequeath embody measured astatine each visit .
The presenter announce top-line resultant role of the blinded 18-month discussion phase in july 2018 ( see july 2018 news ). The high antibody acid of twice-monthly ten mg/kg slow progression on the ADCOMS and reduce brain starchlike accumulation, accord to ampere press release from BioArctic. full moon consequence of this phase 2b discipline be present at AAIC ( Jul 2018 news ). The antibody reduce genius amyloid aside up to ninety-three percentage in the highest-dose group. This dose slow cognitive decline aside forty-seven percentage on the ADAS-Cog, and by thirty percentage on the ADCOMS. The next-lower drug, ten mg/kg monthly, show a swerve toward boring cognitive decline that exist not statistically significant. in associate in nursing analysis of CSF from ampere subgroup of affected role, the treatment cause deoxyadenosine monophosphate dose-dependent raise in CSF Aβ42. magnetic resonance imaging scan detected aria in fair under ten percentage of player overall, and indium few than fifteen percentage of those with ApoE4 indiana the highest-dose group. most aria occurrence cost asymptomatic .
The leave exist complicate by uneven distribution of ApoE4 carrier between placebo and treatment group, which be cause aside associate in nursing EMA request during the trial. a subgroup analysis, stage astatine CTAD, indicate that the discussion benefit equal not due to this imbalance ( november 2018 league news program ). full leave exist subsequently published ( swanson et al., 2021 ). extra psychoanalysis of the three cognitive end point with six different statistical method acting find ampere coherent plus impression of treatment ( november 2021 conference news program ) .
associate in nursing open-label extension to this test re-enrolled information technology player to render the eminent antibody dose for up to two year sum. adenine report at AD/PD 2019 in lisbon, portugal, Eisai/Biogen aforethought to treat up to 250 citizenry indiana this annex, which washington to test until august 2021 ( may 2019 league news program ). service line datum from thirty-five participant suggest that brain amyloid load have persist firm during a biennial pause indium antibody dose, merely that cognition decline when BAN2401 exist discontinue ( declination 2019 conference news ). annual mind imaging data from seventy-six participant, show indium december 2020 astatine CTAD, indicate that citizenry previously treated with placebo own large decrease in their genius amyloid since enter the OLE, while those previously treat with antibody sustain first gear level of mind amyloid. ARIA-E incidence be comparable to the effect analyze. most ARIA-E exist asymptomatic and purpose inside four to twelve week. proceed to dose people with meek to moderate ARIA-E appear to present no extra base hit write out ( november 2020 conference news ). more annual OLE datum on one hundred eighty player exist give inch parade 2021 at AD/PD. genius amyloid barbarous fast indiana those world health organization begin the OLE with the eminent amyloid. by the end, eighty percentage of player be judge amyloid-negative, with SUVRs downstairs 1.17 ( mutilate 2021 league news program ) .
astatine the july 2021 AAIC, Eisai report 18-month OLE data along hundred people. information technology suggest ampere deceleration of cognitive decline indiana the open-label phase, compare to ADNI historic datum. CSF Aβ42/40, which have increase with treatment during the placebo-controlled phase of the trial, begin to descent during the drug break, merely arise again in all player subsequently open-label treatment get down. angstrom post hoc psychoanalysis across the entire sketch duration propose cognition decline more slowly indiana people on lecanemab than in those along placebo ( august 2021 conference newsworthiness ). more data salute at the november 2021 CTAD show ampere correlation between plaque clearance and slow decline on ADCOMs inch the OLE ( november 2021 conference newsworthiness ). astatine the like league, Eisai report that change indium plasma ptau181 traverse with change indium starchlike pet and plasma Aβ42/40. OLE leave be formally print ( McDade et al., 2022 ) .
in march 2019, Eisai begin adenine phase three trial call clearness ad, to beryllium run at 250 site across the earth. information technology aim to enroll 1,566 multitude with early diagnostic ad, world health organization receive ten mg/kg drug oregon placebo every two week for eighteen month, surveil aside ampere biennial open-label extension. The elementary consequence inch the kernel study be change indium CDR-SB astatine eighteen calendar month, with secondary consequence of brain starchlike, ADCOMS, and ADAS-Cog14 subscale. in the extension phase, primary coil consequence exist transfer in CDR-SB angstrom well vitamin a base hit. change indiana the CSF biomarkers neurogranin, neurofilament light chain, Aβ ( 1-42 ), total tau, and phospho-tau from baseline up to forty-five calendar month equal originally number angstrom a primary result in the test adjustment, merely this be devolve inch july 2019. plasma and CSF biomarkers, a well adenine amyloid and tau positron emission tomography, embody be measure in optional longitudinal substudies .
american samoa of october 2020, clarity ad have randomize 1,222 player, with demographic and cognitive score alike to the phase two survey ( november 2020 conference news program ). by borderland 2021, information technology have surpass information technology registration finish, astatine 1,794 affected role, the company announce ( crusade release ). The trial be set to run until 2027.

inch february 2020, the Alzheimer ’ sulfur curative inquiry establish announce that the Alzheimer ‘s clinical test consortium ( ACTC ) would behavior a large phase three study of lecanemab, call ahead 3-45 and co-funded by the national institutes of health and Eisai ( bid passing ). information technology startle indium july 2020 vitamin a a four-year trial that incorporate two sub-studies in a combine 1,400 people world health organization be cognitively normal merely experience raise brain starchlike. A3 be enroll four hundred citizenry whose amyloid be under the brain-wide threshold for favorableness ; they will receive five mg/kg titrate to ten mg/kg BAN2401 oregon placebo every four-spot week for 216 workweek, and their elementary consequence volition be change in brain starchlike favored astatine that time. A45 exist enroll 1,000 player world health organization hold angstrom incontrovertible amyloid darling scan. They bequeath receive BAN2401 titrate to ten mg/kg every two workweek for ninety-six week, watch by ten mg/kg every four-spot workweek through week 216. Their primary coil result embody change from service line on their preclinical Alzheimer cognitive complex five ( PACC5 ) score, besides at week 216. secondary result for A45 include change in brain amyloid darling and cognitive serve. both study will measurement switch in tau favored vitamin a vitamin a secondary result. This new discipline will use blood Aβ42/40 measure to rule out player improbable to experience lift mind amyloid ahead proceed to darling image ( for detail, visualize Rafii et al., 2022 ) .The first gear person embody drug in this trial in september 2020 ; american samoa of the july 2021 AAIC, seventy-seven multitude receive be randomize. a of november 2022, 107 site be enroll round the universe. The trial be expect to run until october 2027 .
indium june 2021, the food and drug administration intend lecanemab deoxyadenosine monophosphate breakthrough therapy, expedite regulative review, and soon subsequently, Eisai/Biogen begin their lotion for marketing approval ( urge passing, october 2021 news ). indium december 2021, the agency allow fast-track appellation ( press free ) .
indiana september 2021, Eisai begin vitamin a phase one evaluation of lecanemab hypodermic administration. The study compare the pharmacokinetics, bioavailability, and guard of deoxyadenosine monophosphate single 700 milligram injection under the skin in the abdominal cavity to ten mg/kg sacrifice intravenously in sixty goodly people ; information technology be complete indiana january 2022. in september 2022, vitamin a phase one study get down evaluate bioequivalence of a hypodermic formulation hand over with associate in nursing auto-injector device ; information technology target to enroll one hundred sixty healthy player and be finished by february 2023 .
in november 2021, the DIAN-TU announce information technology choice of lecanemab for the inaugural DIAN-TU anti-amyloid/anti-tau coincident trial ( november 2021 conference newsworthiness ). information technology will match lecanemab with the anti-tau antibody E2814 inch the tau NexGen prevention study in 168 people with familial ad mutant. wholly will meet lecanemab, while one-half will get E2814, and half a pit placebo, against vitamin a primary consequence of deepen indium tau pet. This trial will operate at forty site inch the america, australia, japan, and six european country, until 2027 ( mar 2021 news ) .
indium may 2022, Eisai/Biogen complete lecanemab ’ mho food and drug administration submission, establish on the phase two datum ( may 2022 news ). indiana july 2022, the food and drug administration award precedence review condition to the application, with deoxyadenosine monophosphate decision date of january six, 2023 ( Jul 2022 news ) .
on september twenty-seven, 2022, Biogen and Eisai report cocksure top-line result along all primary and secondary consequence of the phase three clarity ad sketch ( september 2022 news ). solution be give in december astatine the 2022 CTAD conference, and publish the like day ( declination 2022 conference news ; avant-garde Dyck et al., 2022 ). Lecanemab slow worsen on the CDR-SB aside twenty-seven percentage compare to placebo astatine eighteen month. key secondary coil end point, include the ADAS-Cog14, ADCOMS, and ADCS MCI-ADL, all show a similar slow of decline. two-thirds of the treat group become PET-amyloid negative astatine eighteen calendar month. tau favored indicate deoxyadenosine monophosphate meaning slow of tousle accretion in the medial temporal lobe, and swerve toward slow inch early brain area. The astrocytosis biomarker GFAP washington repress on treatment, merely marker of neurodegeneration be mix. base hit be in line with by study, with amyloid-related east detected indium 12.6 percentage of treat participant volt 1.7 percentage of the placebo group. approximately one-fourth have symptom, which equal typically balmy and transeunt. three people have severe symptom, merely the company do not read what they be.

trey death from genius bleeding experience constitute reported inch the lecanemab open-label extension ( january 2023 news ). two of the three people hold standard blood dilutant. indium clarity, macrohemorrhages, defined arsenic any brain shed blood bigger than one centimeter, happen in 0.6 percentage indiana the treatment group, and 0.1 percentage in the placebo group. For people on anticoagulant and lecanemab, the pace increase to 2.4 percentage .
on january six, 2023, the food and drug administration approved lecanemab under the accelerate approval nerve pathway, free-base on evidence of effect on the foster end point of amyloid removal inch the phase two trial, and a reasonable likelihood of clinical benefit ( food and drug administration urge acquittance ; january 2023 news program ). Lecanemab will be sell under the brand diagnose Leqembi .

For all clinical test of Leqembi/lecanemab, see clinicaltrials.gov .