How the Latest Alzheimer’s Treatments in 2025 Can Extend Independence—What You Need to Know

These drugs are recognized for their role in slowing the progression of early Alzheimer’s disease by addressing brain amyloid, though they are not considered curative. For individuals and families navigating a new Alzheimer’s diagnosis, understanding these therapies—their benefits, risks, eligibility, and access—is important. This article provides an overview of published findings and current information in 2025.

Understanding Kisunla (donanemab) and Leqembi (lecanemab)

Kisunla (donanemab) and Leqembi (lecanemab) are monoclonal antibody therapies that target amyloid beta protein plaques in the brain—features associated with Alzheimer’s disease. Reducing the buildup of this protein has been linked to a slower rate of cognitive decline in patients with early-stage disease.

• Kisunla: FDA-approved in July 2024, marketed by Eli Lilly.
• Leqembi: FDA-approved in mid-2023, marketed by Eisai and Biogen.

These treatments are part of a newer generation of disease-modifying therapies in Alzheimer’s clinical care.

Eligibility Criteria for Treatment

Kisunla and Leqembi are designed for individuals in the early stages of Alzheimer’s disease:

• Mild Cognitive Impairment (MCI) or Mild Dementia due to Alzheimer’s, based on clinical trial criteria.
• Confirmed Amyloid Pathology: Diagnosis requires biomarker evidence (such as a PET scan or cerebrospinal fluid test) that shows abnormal amyloid accumulation.
• Risk Assessment: Genetic testing for the APOE-4 gene is recommended, as those with two copies have a heightened risk of certain side effects.

Ineligible groups: These therapies are not approved for use in moderate to advanced Alzheimer’s, or in individuals without confirmed amyloid pathology.

How Are These Medications Administered?

• Kisunla (donanemab): Administered as an intravenous (IV) infusion once every 4 weeks. Dosing begins at 700 mg for the first three infusions, then increases to 1400 mg monthly.
• Leqembi (lecanemab): Administered as an IV infusion every 2 weeks. A subcutaneous (self-injected) weekly formulation is in late-stage clinical trials and may be approved in the future, potentially providing a more convenient alternative for some patients.

All infusion appointments include monitoring and follow-up for possible side effects.

Effectiveness of These Treatments

Clinical trials and studies indicate that Kisunla and Leqembi can slow symptom progression in adults with early Alzheimer’s:

• Kisunla: Associated with a 20–29% reduction in the rate of clinical decline over 76 weeks compared to placebo, as measured by standardized cognitive and functional assessments.
• Leqembi: Showed a 27–37% reduction in decline over 18 months; the majority of participants experienced decreased amyloid to below diagnostic thresholds.

Impact on Independent Living

These slower progression rates may allow for extended periods of independent functioning. Clinical models estimate:

• Early-Stage (Mild Cognitive Impairment):
  • Kisunla: May result in approximately 8 additional months of independent living.
  • Leqembi: May result in approximately 10 additional months of independence.
• Mild Dementia:
  • Kisunla: Up to 19 months of additional ability for self-care.
  • Leqembi: Up to 26 months of additional self-care capability.

These are estimates derived from clinical studies; individual outcomes will vary.

These therapies are not designed to restore lost memory or improve existing symptoms, but rather to help slow future decline.

Side Effects and Risks

Kisunla and Leqembi may lead to side effects or risks, including:

• Amyloid-Related Imaging Abnormalities (ARIA):
  • Brain swelling (edema) and small areas of bleeding (microhemorrhages), detected by MRI.
  • Most are mild or asymptomatic, but rare serious complications have occurred.
  • Risk is higher in individuals with two copies of the APOE-4 gene.
• Other Side Effects:
  • Headache
  • Infusion reactions (such as flu-like symptoms, blood pressure changes, nausea)
  • Hypersensitivity reactions, including severe allergic responses (such as anaphylaxis or angioedema)
  • Dizziness, confusion, and joint pain (more commonly reported with Leqembi)

Regular MRI scans are generally required throughout treatment to monitor for ARIA. Patients are encouraged to discuss individual risks and benefits with their healthcare provider prior to starting therapy.

Insurance Coverage and Cost Considerations

• Medicare (CMS) Coverage: As of 2025, Kisunla and Leqembi are covered for their FDA-approved indications. Enrollment in a privacy-protected federal registry is required for patients to enable ongoing safety monitoring.
• Out-of-Pocket Costs: Despite Medicare coverage, patients may have co-payments that can total several thousand dollars each year. Additional costs may include imaging studies, clinic appointments, and infusion services. Private insurance coverage may be available depending on plan specifics.
• Financial Assistance: No national financial-assistance programs are universally available at this time. Patients should consult with their healthcare team or financial counselor about individual support options.

What to Expect During Treatment

1. Screening and Diagnosis
   • Confirm early-stage Alzheimer’s and amyloid pathology (using a PET scan or spinal fluid test).
   • Consider APOE-4 genetic testing to assess risk.
2. Enrollment and Insurance
   • Verify insurance coverage and registry participation if required.
3. Initiation of Therapy
   • Schedule biweekly or monthly infusions, depending on the chosen medication.
   • Undergo regular MRI scans for safety monitoring.
   • Participate in regular functional and cognitive evaluations.
4. Ongoing Care
   • Review treatment progress, monitor for side effects, and discuss continued therapy with your physician.

Advancements and Ongoing Research

• The subcutaneous form of Leqembi is in advanced trials and, if approved by the FDA, may allow for at-home administration with a similar safety and efficacy profile as current infusions.
• Clinical research continues for additional disease-modifying therapies; as of 2025, Kisunla and Leqembi are the only widely available FDA-approved options in this category.

Setting Realistic Expectations

These therapies signify progress in Alzheimer’s care but are not a cure. Instead, they are intended to delay progression, which may contribute to a longer period of independent functioning and quality of life for some patients. Decisions about use should involve careful discussions with medical professionals, considering the benefits, risks, monitoring requirements, and individual preferences.

• Kisunla (donanemab) and Leqembi (lecanemab) are currently the leading FDA-approved therapies for early Alzheimer’s in 2025.
• They are shown to slow cognitive and functional decline, but do not stop or reverse the disease.
• Strict eligibility, routine monitoring, and a full understanding of potential side effects and financial considerations are necessary.
• Engage with your healthcare team to determine the most appropriate, individualized care plan.

Sources

• FDA approves treatment for adults with Alzheimer’s disease – Kisunla (donanemab-azbt)
• CNN: How much longer you might live without assistance on new Alzheimer’s drugs
• What to Know About New Alzheimer’s Disease Treatments – NYP Health Matters

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