This newsletter summarizes the recent approval of lecanemab, a humanized monoclonal antibody, for Alzheimer’s disease.
We also discuss practical aspects of pharmacologic management of BPD, key points from a presentation on broad-spectrum micronutrients (BSM) for mental health, and our practical research summaries of adult, child, and adolescent psychiatry (Quick Takes and CAP Smart Takes).
Accelerated Approval of Lecanemab for Alzheimer’s Disease
On January 6, 2023, the FDA approved lecanemab (Leqembi) through the Accelerated Approval pathway to treat Alzheimer’s disease. Accelerated Approval is reserved for therapies for diseases with few treatments.
- How does lecanemab work?
- It is a humanized monoclonal antibody that binds with high affinity to soluble amyloid-beta (Aβ) protofibrils.
- What do we know about its efficacy?
- A phase II trial found that lecanemab decreased brain plaques in 856 participants. Learn more here.
- A phase III trial found that lecanemab slowed cognitive decline by 27% over 18 months of treatment. Learn more here.
- Which dose was proven to be effective?
- Intravenous administration of 10 mg of lecanemab per kilogram of body weight every 2 weeks has been identified as an appropriate dose.
- Which patients are candidates for treatment with lecanemab?
- For now, it is indicated only for patients with mild cognitive impairment or those in the mild dementia stage.
- What are the most common side effects?
- Infusion-related reactions, headaches, falls, visual disturbances, dizziness, and confusion
- What is the greatest risk when using lecanemab?
- It is associated with a condition known as amyloid-related imaging abnormalities, which can manifest as brain swelling and bleeding.
- What is the controversy associated with lecanemab approval?
- Lecanemab is made by the biopharmaceutical companies Eisai and Biogen, the same manufacturers of aducanumab, which was approved in June 2021. Learn more here.
- Aducanumab’s approval was surrounded by controversy because it did not show a strong signal towards improving cognitive decline.
- Finally, patients eligible for being treated with lecanemab have mild cognitive impairment and good functioning; however, they can be at risk due to serious adverse effects.
Pharmacologic Management of BPD: Recent Developments, With Paul Links, M.D.
In this interview, Dr. Paul Links reviews essential principles in the management of borderline personality disorder. He presents therapeutic options, such as psychotherapy, antipsychotics, mood stabilizers, antiadrenergic agents, and omega-3 fatty acids, for the management of borderline personality disorder and its associated symptoms.
Interview highlights include the following:
- Psychotherapy continues to be the main treatment modality for patients with borderline personality disorder.
- Psychotropic medications can be used to manage comorbid disorders, such as depression or anxiety, as well as targeted symptoms, such as impulsivity, aggressiveness, and cognitive–perceptual disturbances.
Learn more and earn 0.5 CME credits here.
Broad-Spectrum Micronutrients (BSM) for Mental Health: Context for Considering Micronutrient Treatment
In this presentation, Dr. Amelia Villagomez discusses using broad-spectrum micronutrients (BSM) for mental health conditions. She reviews the connection between dietary patterns, brain function, and mental health and thoroughly explains the rationale for micronutrient supplementation. Moreover, she analyzes the available evidence of BSMs for psychiatric disorders, such as ADHD and emotional dysregulation in children, depression, anxiety, and premenstrual dysphoric disorder.
Rationale for Micronutrient Supplementation in Mental Illness
- There is strong evidence that poor nutrient intake from diet is: – An epidemic in the United States. – Correlated with mental disorder symptoms. – A risk factor for the emergence of psychiatric symptoms.
- Correcting poor nutrient intake can improve mental health.
- A good diet may not be enough to optimize nutritional factors related to mental health.
- Most Americans are not consuming sufficient amounts of vitamins and minerals.
Learn more and earn 0.75 CME credits here.
Quick Takes: Research, Digested
Neurologic and Psychiatric Risk Trajectories After SARS-CoV-2 Infection
- In adults, the risk of a new mood or anxiety diagnosis is increased relative to the comparison group—but only in the first 2 months after infection.
- By contrast, the risk of a new diagnosis of psychosis persists, at least slightly relative to the rate in the comparison group, at 2 years after infection. Learn more.
Listen to or read the full volume, and earn 0.5 CME credits here.
CAP Smart Takes: Research, Digested
Nonstimulant Treatments for ADHD
- Nonstimulant treatments may be especially effective for certain populations of ADHD comorbidity, such as:
- Atomoxetine for ADHD with comorbid anxiety.
- Viloxazine for ADHD with comorbid depression.
- Alpha-2 extended-release agents for patients with hyperarousal, aggression, tics, or insomnia or when adjunct treatment is needed with stimulants. Learn more.
Listen to or read the full volume, and earn 0.5 CME credits here.
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References
- Food and Drug Administration. (2023, January 6). FDA grants accelerated approval for Alzheimer’s disease treatment. https://www.fda.gov/news-events/press-announcements/fda-grants-accelerated-approval-alzheimers-disease-treatment
