April 22, 2026

@michaelokun

Lecanemab and long term Alzheimer’s: are we finally bending the curve? Low baseline tau seems to be important. Amyloid refers to sticky protein clumps in the brain that are believed to contribute to Alzheimer's disease. Christopher van Dyck and colleagues describe in an abstract from this years American Academy of Neurology meeting the most recent findings from the Clarity AD open label extension study examining up to 48 months of treatment w/ lecanemab in early Alzheimer’s disease. Key points: - Lecanemab treatment showed continued slowing of cognitive and functional decline through 48 months compared to matched controls. - Treatment differences increased over time suggesting a possible cumulative or durable disease modifying effect. - A meaningful proportion of participants showed no decline or even improvement especially in those w/ low baseline tau. My take: This is important as longitudinal signals in Alzheimer’s disease matter. The idea that treatment effects may grow over time is provocative and raises the possibility that early and sustained intervention could meaningfully alter trajectory. At the same time we must remain cautious as these are open label extension data, and longer term real world validation will also matter. Here are 5 points that resonated w/ me: 1- Early treatment may be key to maximizing benefit in Alzheimer’s disease. 2- Slowing decline over years rather than months is what folks and families care about most. 3- The subgroup w/ low tau may represent a window where intervention is most effective. 4- Safety signals appear stable over time which is reassuring for ongoing use. 5- The future may include combining amyloid therapies w/ other approaches to further shift the disease course. https://index.mirasmart.com/AAN2026/PDFfiles/AAN2026-004068.html #michaelokun #fixelinstitute #alzheimer