The European Union's drugs regulator, the Committee for Medicinal Products for Human Use (CHMP), has recommended the approval of Eisai and Biogen's Leqembi for a subset of patients with early Alzheimer's disease. This decision reverses an initial rejection from four months prior and could pave the way for the EU's first treatment for the neurodegenerative condition, pending approval by the European Commission.
The CHMP's recommendation is specific to patients with early-stage Alzheimer's who have one or no copies of the ApoE4 gene variant. This genetic factor is associated with an earlier onset of the disease, and clinical trials for Leqembi included patients with varying ApoE4 gene copies.
Initial Concerns and Re-evaluation
In July, the EU regulator initially rejected Leqembi due to concerns that the risk of serious brain swelling, also known as ARIA (Amyloid-Related Imaging Abnormalities), outweighed the drug's modest impact on slowing cognitive decline. However, after further review, the agency concluded that the benefits of Leqembi in slowing the progression of disease symptoms are greater than its risks in patients with one or no copy of the ApoE4 gene variant.
The regulator highlighted that patients with only one or no copy of ApoE4 are less likely to experience the serious side effects of brain swelling and potential bleeding observed in trials. This refined understanding of the risk-benefit profile led to the revised recommendation.
Clinical Implications
Leqembi (lecanemab) is an amyloid beta-directed antibody designed to reduce amyloid plaques in the brain, a hallmark of Alzheimer's disease. The clinical trials demonstrated a slowing of cognitive decline in patients treated with Leqembi compared to placebo. However, the drug is also associated with the risk of ARIA, which can manifest as brain swelling or bleeding.
The CHMP's recommendation reflects a careful consideration of these factors, balancing the potential benefits of slowing disease progression against the risks of adverse events, particularly in the context of ApoE4 gene status. The decision underscores the importance of genetic screening and personalized medicine approaches in the treatment of Alzheimer's disease.
