At the Ready for a New Standard of Alzheimer's Care: Preparing Your Practice for the New Era of Amyloid-Targeting Therapies

Co-Chairs, Gil Rabinovici, MD, and David A. Wolk, MD, FAAN, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/MOC/NCPD/AAPA activity titled “At the Ready for a New Standard of Alzheimer's Care: Preparing Your Practice for the New Era of Amyloid-Targeting Therapies.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/NCPD/AAPA information, and to apply for credit, please visit us at https://bit.ly/41D5Vj1. CME/MOC/NCPD/AAPA credit will be available until October 7, 2025.

1. Educating Your Patients and Their Care Partners About
Amyloid-Targeting Therapies (ATTs)
1-4

Full abbreviations, accreditation, and disclosure information available at PeerView.com/GBW40 Receiving a diagnosis of Alzheimer’s disease can be overwhelming for
patients and their care partners. Please share this printable resource with
your patients and their care partners to help educate them about the new
disease-modifying therapies that are available for the treatment of mild
cognitive impairment or mild dementia due to Alzheimer’s disease.
Printable Resource

2. Commonly Asked Questions About Amyloid-Targeting Therapies (ATTs) What are the new FDA-approved treatment options for Alzheimer’s disease (AD), and how
do they work?
Lecanemab and donanemab are two new FDA-approved amyloid-targeting therapies for the treatment of early symptomatic AD. They are
monoclonal antibodies (proteins that help your immune system target specific proteins for removal), and they are designed to remove the
buildup of the amyloid beta protein in the brain. Amyloid beta is an important protein involved in the progression of AD.
Studies show that lecanemab and donanemab reduce the buildup of amyloid beta, and they also slow down cognitive decline in patients with
mild cognitive impairment (MCI) or mild dementia caused by AD. 
Who is eligible to receive ATTs?
People with MCI or mild dementia due to AD may be eligible to receive amyloid-targeting therapies.
What assessments are used to determine eligibility?
1. A history and assessment of cognition and day-to-day function: This assessment, completed by your primary care provider or
Alzheimer’s disease specialist, determines if you have mild cognitive impairment or mild-stage dementia.
2. Magnetic Resonance Imaging (MRI) scan of the brain: This scan determines if you have evidence of micro-hemorrhages (small areas
of blood in the brain that are common in people with AD) or other brain changes that may increase the risks of ATTs.
3. Blood work: Blood work helps to determine if there are causes of cognitive impairments other than AD.
4. A test for the presence of amyloid beta in the brain: This test can be a Positron Emission Tomography (PET) scan, a spinal fluid
sample obtained using a lumbar puncture, or a blood test (if available).

3. Commonly Asked Questions About ATTs (Cont’d)  
What are the potential side effects of ATTs?
ARIA: The main side effects of ATTs are microscopic hemorrhages (small bleeds) and edema in the brain called amyloid-related imaging
abnormalities or ARIA. ARIA is caused by inflammation around the small blood vessels in the brain. In most patients, ARIA is asymptomatic.
It is detected using an MRI scan, but a minority of people with ARIA have mild symptoms, and a small number have more serious and
permanent neurological outcomes. People who carry a specific gene version called APOE-ε4 a re more susceptible to developing ARIA as well
as serious complications from ARIA (especially if they carry two copies of the
APOE-ε4 ge ne version). All patients must receive AP OE gene
testing before starting treatment with ATTs, so they can understand their unique risk of ARIA before moving forward with treatment.
Infusion reactions: Another common side effect of this class of therapy is an infusion reaction, usually after the first dose. Infusion reactions
involve immune responses to drugs given through the blood and may include changes in blood pressure, changes in breathing, skin changes,
fevers, and chills. While infusion reactions can be dangerous, the majority of infusion reactions related to ATTs have been easily treatable and
not severe.
Other side effects include headaches, diarrhea , and falls.
Are there any contraindicated medications that cannot be taken with ATTs?
Because of the risk of bleeding associated with ATTs, people on strong blood thinners (“anti-coagulants”) should not receive these
treatments. To date, there have been a handful of deaths that have occurred from brain bleeding in patients treated with ATTs, including people
who died after receiving a “clot-busting” medication to treat a stroke.

4. Donanemab vs Lecanemab: Side-by-Side Comparison Donanemab Lecanemab
Treatment schedule
Once-a-month clinic visits
for IV treatment, usually in
outpatient infusion centers 
Twice-a-month clinic visits
for IV treatment, usually in
outpatient infusion centers 
Infusion time 30 min 60 min
Duration of treatment
Many patients can stop after
about 18 months if amyloid
levels decrease significantly
Usually taken long term
MRI monitoring schedules
Safety MRI prior to 2nd,
3rd, 4th, and 7th dose
Safety MRI prior to 5th, 7th,
and 14th dose
Efficacy
In trials, donanemab slowed
the decline in memory and
thinking skills by about 35%
In trials, lecanemab slowed
the decline in memory and
thinking skills by about 27%
Transportation and time spent on
treatment: Is the patient able to make visits
to infusion centers once or twice a month?
Discontinuation of treatment may
depend on receiving an amyloid PET scan
to evaluate amyloid-plaque clearance
Monitoring: Is the patient willing to have
regular brain scans and blood tests?
Things to Consider

5. Important ARIA Symptoms to Watch Out For 1. Kisunla (donanemab) Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/761248s000lbl.pdf. 2. Leqembi (lecanemab) Prescribing Information. https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/761269Orig1s001lbl.pdf. 3. Day GS
et al. Neurology. 2022;98:619-631. 4. Ramanan VK et al. Neurology. 2023;101:842-852.
ARIA is usually asymptomatic; however, sometimes ARIA presents with these symptoms
Call Your Doctor Immediately if You Experience Any of These Symptoms!
Headache
Neuropsychiatric
symptoms
Visual disturbance/
blurred vision
Confusion and dizziness
Gait disturbance
Nausea
Seizure

6. Shared Decision-Making in Alzheimer's Care:
Considerations for Collaborative Discussions
Between Patients, Care Partners, and Providers
Full abbreviations, accreditation, and disclosure information available at
PeerView.com/GBW40 What Is Shared Decision-Making (SDM)? What Are the Components of SDM? A collaborative process between the patient, care partner, and
healthcare provider to make a treatment-related decision
Provider assesses patient’s and care partner’s understanding and
answers questions they may have
Provider shares information with patient and care partner about
•Potential benefits of treatm
ent
•Potential risks of treatment
•Uncertainties, burden, and costs of treatment
•Alternative treatm
ent options and their risks and benefits
•Expected outcome if no treatment is pursued
Provider supports active participation in a two-way conversation with the
patient and care partner to
• Identify patient’s needs, values, preferences, and goals
• Make a treatment decision in collaboration with the patient and care partner that reflects
the best interests of the patient

7. Shared Decision-Making in Alzheimer's Care:
Considerations for Collaborative Discussions
Between Patients, Care Partners, and Providers
Full abbreviations, accreditation, and disclosure information available at
PeerView.com/GBW40 How to Engage Patients and Care Partners in SDM How Does SDM Benefit Patients? Essential Practices for Successful SDM
Assess patient’s preferred method of receiving information
• Try providing information using a multimedia approach—verbal face-to-face, printed
materials, video links
Elicit patient’s preferred level of involvement
• Some patients are more open to taking an active role in their healthcare decisions,
while others prefer to let their provider take the lead
Assess patient’s concerns
• Patients often receive incomplete or inaccurate information from friends, news, or the
internet, whic
h can trigger mis conceptions or concerns
• Being aware of and responding to these concerns is critical to ensure that the patient
is receiving tailor
ed support in nav igating and understanding av ailable treatment options
SDM can help patients
• Adhere to therapy and achieve their treatment goals
• Monitor for worsening disease or side effects
• Trust their providers and collaborate with them

8. Patient Support Resources for FDA-Approved
Treatments for Alzheimer's Disease
Full abbreviations, accreditation, and disclosure information available at
PeerView.com/GBW40 Lecanemab
eisaipatientsupport.com/hcp/leqembi
• Enrollment form
• Coding quick reference guide
• Sample letters
–Medical necessity
–Appeals
–Exception request
• Prior authorization checklist
• Specialty distributor guide
• Health insurance brochure
for patients
• Patient support enrollment form
• Care coordination form
• Billing and coding guide
• Prescriber's guide
• EHR resources
• Sample medical necessity letter
• Appeal form
• Infusion checklist
• Infusion preparation handbook
• Patient wallet card
Donanemab
kisunla.lilly.com/hcp/support-resources
Use the QR codes or links below to learn about resources available for use in
providing support for patients eligible for therapy.
Print and share the next page with patients to help them learn
more about support resources
Each website has downloadable resources, including:

9. Are You or Someone You Care for Eligible for Treatment to Reduce Amyloid
Plaques Associated With Early Symptomatic Alzheimer’s Disease?
Patient support programs can make the treatment journey more manageable. Use
this page to learn what resources are available to patients and care partners.
Information on:
Insurance coverage
What to expect at each step of the treatment journey
Treatment costs
Getting started with treatment
Locating an infusion center
Lecanemab (Leqembi) Donanemab (Kisunla)
Eisai Patient Support Lilly Support Services
NAME OF SUPPORT PROGRAM
OTHER RESOURCES
Scan these QR codes for more information
about support options for each FDA-approved medication
FINANCIAL SUPPORT
Options vary depending on whether patients have private insurance,
Medicare, Medicaid, or no insurance
Copay assistance program
Temporary supply program
Savings card program
Patient assistance program
kisunla.lilly.com/support-resources
eisaipatientsupport.com/patient/
leqembi