The European Medicines Agency's (EMA) Committee for Medicinal Products for Human Use (CHMP) has shifted its position on Leqembi (lecanemab), an anti-amyloid monoclonal antibody, now recommending its approval for the treatment of Alzheimer's disease, contingent upon restricting its use to patients with specific genetic profiles. This decision comes after an initial rejection due to concerns about the drug's safety profile relative to its clinical benefits.
The CHMP's revised recommendation stipulates that Leqembi should only be administered to patients who carry zero or one copy of the APOE4 allele. This restriction is based on data indicating that individuals with two copies of the APOE4 allele are at a significantly higher risk of developing amyloid-related imaging abnormalities (ARIA), including brain swelling and bleeding, which were key factors in the committee's initial negative assessment.
The initial concerns raised by the CHMP centered on the modest clinical benefit observed with Leqembi in the context of these serious safety risks. However, after further review and analysis, the committee concluded that the benefit-risk profile is positive for Alzheimer's patients who do not possess the high-risk APOE4 genotype. Eisai Co. Ltd. and Biogen Inc., the developers of Leqembi, have not yet released statements regarding the updated decision.
Leqembi's efficacy in slowing cognitive decline in early Alzheimer's disease was demonstrated in clinical trials, offering a potential new treatment option for a disease with limited therapeutic interventions. However, the risk of ARIA, particularly in APOE4 homozygotes, has been a persistent concern. The CHMP's decision reflects a cautious approach, balancing the potential benefits of Leqembi with the need to mitigate serious adverse events in vulnerable patient populations. The decision underscores the importance of genetic testing in identifying appropriate candidates for Leqembi treatment and minimizing the risk of ARIA.
