Kisunla among recent drugs approved for mild Alzheimer’s

According to the U.S. Centers for Disease Control and Prevention, an estimated 6.7 million Americans are affected by Alzheimer’s disease, and it’s one of the top 10 leading causes of death in the United States. While there isn’t a cure, the FDA has approved a few medications to slow the disease’s progression or to help manage symptoms. The most recent addition to that list is donanemab, sold under the brand name Kisunla.

Kisunla is an infusion designed to help patients with mild Alzheimer’s. To better understand this drug, other available Alzheimer’s treatments and what interventions are on the horizon, we talked to two leading Alzheimer’s researchers.

“Alzheimer’s disease is a very specific cause of cognitive impairment where you have the abnormal accumulation of a couple of proteins, such as amyloid and tau,” says Dr. Chad Hales, an assistant professor of neurology at Emory University. This protein accumulation causes brain cells to get sick and die off, leading to Alzheimer’s.

The disease can be divided into three main stages:

Hales adds that the disease typically lasts 10 to 15 years. However, the condition’s duration varies, depending on the disease’s progression and a patient’s age. Someone diagnosed at 84, for example, may only live three to four years longer while someone diagnosed at 60 may live for 15 more years.

There isn’t a cure to Alzheimer’s or a way to prevent it. There are, however, three classes of medication that can help manage symptoms or slow the disease’s progression.

The first and best-established class of drugs manage specific symptoms, such as depression or hallucinations, Hales says. The exact drugs prescribed for symptom management differ on a case-by-case basis.

Cholinesterase inhibitors are the second class of drugs on the market. These are prescribed to manage symptoms of mild or moderate Alzheimer’s. Galantamine, rivastigmine and donepezil are the three most common drugs in this class.

The third and newest class is immunotherapy drugs prescribed during the earliest stage of Alzheimer’s. This is the class where the recently approved Kisunla fits in, but it’s not the first.

“The first one to be FDA approved was called aducanumab, and that drug had unclear benefits and high rates of side effects. It is no longer available in the United States. The second FDA approved drug in this class is quite a good drug, and it’s called Lecanemab,” says Dr. Andrew Budson, a professor of neurology at Boston University Chobanian & Avedisian School of Medicine.

He explains that the third class of drugs targets amyloid plaque, protein buildup that leads to cognitive decline, in order to slow Alzheimer’s progression. While someone can only take one drug in this third class, Lecanemab or Kisunla can be paired with medications from the other two classes.

Kisunla is a monthly treatment, delivered via a 30-minute infusion. In the first three months of treatment, 700 mg of the drug is administered. Then, 1,400 mg is prescribed for the remaining months in the treatment plan. After an infusion is complete, patients are kept for at least 30 minutes to ensure there are no adverse reactions.

The difference between the two FDA-approved drugs in this class, lecanemab and Kisunla, are the drugs’ targets.

Lecanemab targets protofibrils and fibrils, two main components of amyloid plaque, while Kisunla targets amyloid plaques more broadly. Both drugs accomplish the same goal: to slow cognitive decline and stabilize Alzheimer’s symptoms.

Kisunla’s manufacturer reports the drug can reduce cognitive decline by over 35% in 76 weeks in patients with early stage Alzheimer’s. The key, however, is that the drug works in the earliest stage.

Budson outlines three criteria many doctors use to categorize early stage Alzheimer’s:

While effective, Kisunla is not without side effects. The most common ones, according to the drug’s manufacturer, include: Headaches, dizziness, nausea, trouble walking, confusion, vision changes, inflammation and brain swelling

If severe, brain swelling can lead to more serious side effects, such as a stroke or seizure. Medicines to reduce swelling, including over-the-counter options like Tylenol, work well for most patients, adds Budson, but there is always a risk of more serious complications.

While available to the public, not all health insurance plans cover Kisunla’s cost. If on a private plan, including a Medicare Advantage plan, check with a provider about coverage and costs. Original Medicare usually covers Kisunla, and the drug’s manufacturer expects Medicare Part B will cover the cost of treatment for 98% of patients.

Alzheimer’s care is evolving. Blood tests, for example, are being developed to diagnose Alzheimer’s with a higher degree of certainty. “My expectation is, within the next one to two years, these blood tests will be routinely used to confirm that Alzheimer’s disease is present,” Budson says.

Budson also mentions that experimental treatments, such as altering the gut microbiome or inducing different brain rhythms, are being tested against Alzheimer’s. Most, if not all of these treatments, are highly experimental and in the trial stage, meaning they are not viable treatment options right now.

While pharmaceutical treatments are available, brain-healthy habits may prevent or slow Alzheimer’s too. Specific lifestyle habits that have been identified as helpful to prevent or slow Alzheimer’s include:

These brain-healthy habits compound over time and work better together. “The amount of improvement from one lifestyle change is probably tiny,” Hales explains, “but if you start to add a lot together, it may be quite helpful.”

While scientists have yet to find a treatment that reverses or prevents Alzheimer’s, the number of medications to slow the disease and manage symptoms is growing. Plus, researchers are finding more evidence to support lifestyle interventions as a way to lower the risk of Alzheimer’s.