What is Aducanumab: Uses, Dosage, Side Effects and More

Aducanumab is a prescription medication designed to treat Alzheimer's disease by targeting amyloid beta plaques in the brain. It's given through an intravenous (IV) infusion in a healthcare setting and represents one of the first treatments specifically approved to address the underlying disease process of Alzheimer's rather than just managing symptoms.

This medication has generated significant attention in the medical community because it takes a different approach to treating Alzheimer's disease. While other medications focus on helping with memory and thinking symptoms, aducanumab works by trying to clear harmful protein deposits that build up in the brains of people with Alzheimer's disease.

What is Aducanumab?

Aducanumab is a monoclonal antibody medication that targets amyloid beta plaques in the brain. These plaques are sticky protein deposits that accumulate in the brains of people with Alzheimer's disease and are thought to contribute to the progression of the condition.

The medication is manufactured as Aduhelm by Biogen and received FDA approval in 2021. It's specifically designed for people with mild cognitive impairment or mild dementia due to Alzheimer's disease. The drug works by binding to amyloid beta proteins and helping the body's immune system clear these harmful deposits from brain tissue.

This treatment represents a significant shift in Alzheimer's care because it's the first medication approved that aims to slow the disease's progression rather than just treating symptoms. However, it's important to understand that aducanumab is not a cure for Alzheimer's disease.

What is Aducanumab Used For?

Aducanumab is specifically approved to treat mild cognitive impairment and mild dementia caused by Alzheimer's disease. It's intended for people in the early stages of the condition who still have some independence in their daily activities.

Your doctor will typically recommend this medication if you have confirmed amyloid beta plaques in your brain, which can be detected through specialized brain scans or spinal fluid tests. The medication is not suitable for people with moderate to severe Alzheimer's disease, as clinical studies focused on earlier stages of the condition.

The goal of treatment is to slow down the progression of cognitive decline and preserve thinking abilities for as long as possible. While the medication may help reduce amyloid plaques in the brain, the clinical benefits in terms of memory and thinking improvements have been debated among healthcare professionals.

How Does Aducanumab Work?

Aducanumab works by targeting and binding to amyloid beta plaques that accumulate in the brains of people with Alzheimer's disease. Think of these plaques as harmful debris that interferes with normal brain cell communication and function.

Once the medication binds to these plaques, it signals your body's immune system to help clear them away. This process is called immunotherapy, where the medication essentially teaches your immune system to recognize and remove these harmful protein deposits more effectively.

The medication is considered a targeted therapy because it focuses on a specific aspect of Alzheimer's disease pathology. However, it's important to understand that this is a relatively new approach, and researchers are still studying exactly how much clinical benefit patients may experience from plaque removal.

How Should I Take Aducanumab?

Aducanumab is given only through intravenous infusion at a healthcare facility, typically a hospital or specialized infusion center. You cannot take this medication at home, as it requires careful monitoring by trained healthcare professionals.

The infusion process takes about one hour, and you'll need to be observed for at least one hour afterward to monitor for any immediate reactions. Your healthcare team will check your vital signs and watch for any concerning symptoms during and after the treatment.

Before each infusion, you may need to take pre-medications to help prevent infusion reactions. These might include antihistamines or medications to reduce inflammation. Your healthcare provider will discuss this with you and ensure you're comfortable throughout the process.

You don't need to fast before your infusion, but it's a good idea to eat a light meal beforehand and stay well-hydrated. Wearing comfortable clothing and bringing something to keep you occupied during the infusion can help make the experience more pleasant.

How Long Should I Take Aducanumab For?

The duration of aducanumab treatment varies depending on your individual response and tolerance to the medication. Currently, there isn't a standard endpoint for treatment, as this is a relatively new therapy for Alzheimer's disease.

Your doctor will closely monitor your progress through regular brain scans, cognitive assessments, and overall health evaluations. These appointments help determine whether the medication is providing benefit and whether it's safe for you to continue treatment.

Treatment typically continues as long as you're tolerating the medication well and your healthcare team believes it's providing benefit. Some people may need to pause or discontinue treatment if they develop concerning side effects, particularly brain swelling or bleeding.

The decision to continue or stop treatment should always be made in partnership with your healthcare provider, considering your overall health, quality of life, and treatment goals. Regular communication with your medical team is essential throughout your treatment journey.

What Are the Side Effects of Aducanumab?

Like all medications, aducanumab can cause side effects, ranging from mild to serious. Understanding these potential reactions can help you feel more prepared and know when to contact your healthcare provider.

The most common side effects you might experience include headache, confusion, dizziness, and nausea. These symptoms are often mild and may improve as your body adjusts to the treatment over time.

Here are the more frequent side effects that patients report:

• Headache and fatigue
• Confusion or disorientation
• Dizziness or feeling unsteady
• Nausea and digestive upset
• Infusion site reactions like redness or swelling
• Sleep disturbances

While these common side effects can be uncomfortable, they typically don't require stopping treatment and can often be managed with supportive care and time.

However, there are more serious side effects that require immediate medical attention, particularly a condition called ARIA (Amyloid-Related Imaging Abnormalities). This involves brain swelling or small areas of bleeding that can be detected on brain scans.

Here are the serious side effects that warrant immediate medical care:

• Severe headache that doesn't respond to usual pain relievers
• Sudden confusion or significant changes in thinking
• Vision problems or visual disturbances
• Seizures or unusual muscle movements
• Difficulty walking or maintaining balance
• Nausea and vomiting that prevents eating or drinking

These serious side effects are less common but can be potentially dangerous, which is why regular brain monitoring with MRI scans is an essential part of your treatment plan.

Rare but serious complications can include severe allergic reactions during infusion, significant brain swelling that causes symptoms, and in very rare cases, serious bleeding in the brain. Your healthcare team is trained to recognize and manage these complications should they occur.

Who Should Not Take Aducanumab?

Aducanumab isn't appropriate for everyone with Alzheimer's disease. Your healthcare provider will carefully evaluate whether this medication is right for your specific situation.

People with moderate to severe Alzheimer's disease should not receive aducanumab, as the clinical studies only included patients with mild cognitive impairment or mild dementia. The medication hasn't been shown to be effective in more advanced stages of the disease.

You should not receive aducanumab if you have a known allergy to the medication or any of its components. Additionally, people with certain bleeding disorders or those taking specific blood-thinning medications may not be good candidates for this treatment.

Here are conditions and situations where aducanumab may not be recommended:

• Moderate to severe Alzheimer's disease
• Known hypersensitivity to aducanumab
• Active bleeding disorders
• Recent stroke or brain injury
• Uncontrolled high blood pressure
• Pregnancy or breastfeeding

Your doctor will also consider your overall health, other medications you're taking, and your ability to undergo regular monitoring when determining if aducanumab is appropriate for you.

People who cannot undergo regular MRI scans due to medical implants or severe claustrophobia may not be suitable candidates, as brain monitoring is a crucial part of safe treatment with this medication.

Aducanumab Brand Name

Aducanumab is sold under the brand name Aduhelm, manufactured by Biogen. This is currently the only brand name available for this medication in the United States.

The full generic name is aducanumab-avwa, which helps distinguish it from other potential formulations that might be developed in the future. When discussing this medication with your healthcare provider or pharmacist, you can refer to it by either name.

Aduhelm is only available through specialized healthcare facilities and requires special handling and administration procedures. You cannot obtain this medication through regular retail pharmacies, as it must be prepared and administered in clinical settings.

Aducanumab Alternatives

Currently, there are limited alternatives to aducanumab for targeting amyloid plaques in Alzheimer's disease. However, there are other medications available to help manage Alzheimer's symptoms, though they work differently than aducanumab.

Traditional Alzheimer's medications include cholinesterase inhibitors like donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne). These medications help with memory and thinking symptoms but don't target the underlying disease process like aducanumab does.

Another option is memantine (Namenda), which works by regulating brain chemical activity and may help with moderate to severe Alzheimer's symptoms. Some people take combinations of these medications depending on their stage of disease and individual needs.

Recently, another amyloid-targeting medication called lecanemab (Leqembi) has also received FDA approval. This medication works similarly to aducanumab by targeting amyloid plaques but has shown different clinical trial results.

Your healthcare provider can help you understand which treatment approach might be most appropriate for your specific situation, considering your disease stage, overall health, and treatment preferences.

Is Aducanumab Better Than Lecanemab?

Comparing aducanumab to lecanemab is complex because both medications target amyloid plaques but have shown different results in clinical trials. Neither medication is definitively "better" than the other, as the choice depends on individual patient factors.

Lecanemab has demonstrated more consistent evidence of slowing cognitive decline in clinical trials, while aducanumab's clinical benefits have been more controversial within the medical community. However, both medications carry similar risks, particularly the potential for brain swelling and bleeding.

The side effect profiles of both medications are quite similar, with ARIA (brain swelling or bleeding) being a concern for both treatments. The frequency and severity of these side effects may vary slightly between the two medications.

Your healthcare provider will consider several factors when choosing between these options, including your specific disease characteristics, other health conditions, and your personal preferences about treatment goals and monitoring requirements.

Both medications require regular brain monitoring and are given through IV infusion, so the treatment experience is quite similar. The decision often comes down to which medication your doctor believes is most appropriate based on current research and your individual medical situation.