Lilly's Kisunla™ (donanemab-azbt) Approved by the FDA for the Treatment of Early Symptomatic Alzheimer's Disease

Rhea-AI Summary

The FDA has approved Eli Lilly's Kisunla (donanemab-azbt) for treating early symptomatic Alzheimer's disease (AD). The drug significantly slowed cognitive and functional decline by up to 35% in its Phase 3 trial and reduced the risk of disease progression by 39%. Kisunla, administered as a 30-minute monthly IV infusion, targets amyloid plaques and can stop therapy once plaques are removed, potentially lowering treatment costs. In the trial, nearly half of participants completed treatment within 12 months. Kisunla reduced amyloid plaques by 84% on average over 18 months. The treatment also carries risks of amyloid-related imaging abnormalities (ARIA) and allergic reactions.

Positive

• FDA approval for treating early symptomatic Alzheimer's disease.
• 35% reduction in cognitive and functional decline in Phase 3 trial.
• 39% decrease in risk of disease progression.
• Reduced amyloid plaques by 84% over 18 months.
• Potential to stop therapy after plaque removal, lowering costs.
• 47% of trial participants completed treatment within 12 months.

Negative

• Risk of amyloid-related imaging abnormalities (ARIA).
• Potential for serious and life-threatening allergic reactions.
• High treatment costs, up to $48,696 for 18 months of therapy.

Insights

Financial Analyst

The approval of Kisunla™ by the FDA for the treatment of early symptomatic Alzheimer's disease is a substantial milestone for Eli Lilly and Company. From a financial perspective, the approval has the potential to significantly impact revenue streams over the coming years, given the high demand for effective Alzheimer's treatments. With up to 35% improvement in cognitive and functional decline over 18 months, this product is likely to see strong adoption among healthcare providers and patients. Additionally, the possibility of stopping treatment after achieving minimal levels of amyloid plaques can reduce long-term treatment costs, making it more appealing.

However, investors should also be mindful of the competitive landscape in the Alzheimer's treatment market. Other amyloid plaque-targeting therapies are being developed and approved, which could dilute Kisunla's market share. Furthermore, the potential side effects, such as amyloid-related imaging abnormalities (ARIA), may also affect its adoption rate and market performance.

Overall, while the short-term financial outlook appears promising with this approval, it will be important to monitor the competitive dynamics and long-term safety profile of Kisunla.

Medical Research Analyst

The FDA approval of Kisunla™ is a significant advancement in Alzheimer's disease management. The evidence showing that Kisunla can slow cognitive decline by up to 35% in early symptomatic patients is compelling. Importantly, the ability to stop treatment after achieving minimal amyloid levels is unique and can reduce patient burden and healthcare costs.

However, the potential side effects like ARIA, which involve brain swelling and bleeding, cannot be overlooked. These side effects underscore the need for careful patient monitoring and management. The efficacy data from the Phase 3 study is robust, yet the variance in response among different patient groups (based on tau protein levels) indicates that personalized treatment approaches might be necessary for optimal outcomes.

Clinically, Kisunla's approval is a leap forward, but ongoing post-market surveillance and real-world data will be important in understanding the full impact and safety profile of this treatment.

Market Research Analyst

The introduction of Kisunla™ into the market provides a new option for early symptomatic Alzheimer's patients, a segment in dire need of effective treatments. From a market standpoint, this approval expands Eli Lilly's portfolio into a high-demand therapeutic area. The limited-duration treatment regimen is particularly noteworthy as it differentiates Kisunla from other treatments, potentially leading to greater market penetration by offering cost savings over time.

The reimbursement under Medicare and the inclusion in the Lilly Cares Foundation are strategic moves to enhance accessibility and affordability, which could drive initial uptake quickly. The company's support programs will help mitigate financial barriers, further increasing patient access and adherence.

However, market entry challenges remain, especially in educating healthcare providers and patients about the new treatment paradigm and managing expectations regarding side effects. The landscape is competitive and continuous innovation and patient education will be key factors in maintaining market share.

Kisunla slowed cognitive and functional decline by up to 35% compared to placebo at 18 months in its pivotal Phase 3 study and reduced participants' risk of progressing to the next clinical stage of disease by up to 39% 

Kisunla is the first and only amyloid plaque-targeting therapy that used a limited-duration treatment regimen based on amyloid plaque removal; nearly half of study participants completed their course of treatment with Kisunla in 12 months

Once-monthly infusions of 30 minutes reduced amyloid plaques on average by 84% compared to the start of the study

INDIANAPOLIS, July 2, 2024 /PRNewswire/ -- The U.S. Food and Drug Administration (FDA) approved Kisunla™ (donanemab-azbt, 350 mg/20 mL once-monthly injection for IV infusion), Eli Lilly and Company's (NYSE: LLY) Alzheimer's treatment for adults with early symptomatic Alzheimer's disease (AD), which includes people with mild cognitive impairment (MCI) as well as people with the mild dementia stage of AD, with confirmed amyloid pathology.^{1, 2} Once-monthly Kisunla is the first and only amyloid plaque-targeting therapy with evidence to support stopping therapy when amyloid plaques are removed, which can result in lower treatment costs and fewer infusions.^3-6 

"Kisunla demonstrated very meaningful results for people with early symptomatic Alzheimer's disease, who urgently need effective treatment options. We know these medicines have the greatest potential benefit when people are treated earlier in their disease, and we are working hard in partnership with others to improve detection and diagnosis," said Anne White, executive vice president and president of Lilly Neuroscience, Eli Lilly and Company. "Our deepest thanks to the patients and their loved ones for participating in our clinical programs and to Lilly scientists and collaborators persevering over decades of research. Each year, more and more people are at risk for this disease, and we are determined to make life better for them."

Amyloid is a protein produced naturally in the body that can clump together to create amyloid plaques. The excessive buildup of amyloid plaques in the brain may lead to memory and thinking issues associated with Alzheimer's disease.^{7, 8} Kisunla can help the body remove the excessive buildup of amyloid plaques and slow the decline that may diminish people's ability to remember new information, important dates, and appointments; plan and organize; make meals; use household appliances; manage finances; and be left alone.^{1, 7-9}

In the TRAILBLAZER-ALZ 2 Phase 3 study, people who were the least advanced in the disease experienced the strongest results with Kisunla. Trial participants were analyzed over 18 months in two groupings: one group who was less advanced in their disease (those with low to medium levels of tau protein) and the overall population, which also included participants with high tau levels.^{1, 10, 11} Treatment with Kisunla significantly slowed clinical decline in both groups.¹ Those individuals treated with Kisunla who were less advanced in their disease showed a significant slowing of decline of 35% compared with placebo on the integrated Alzheimer's Disease Rating Scale (iADRS), which measures memory, thinking, and daily functioning. In the overall population, the response to treatment was also statistically significant using the iADRS at 22%.^{1, 12} Among the two groups analyzed, participants treated with Kisunla had up to a 39% lower risk of progressing to the next clinical stage of disease than those taking placebo.¹³

Among the overall population of participants, Kisunla reduced amyloid plaques on average by 61% at 6 months, 80% at 12 months, and 84% at 18 months compared to the start of the study.^{1, 14} One of the treatment goals of the study was to remove amyloid plaques to minimal levels consistent with a visually negative scan using amyloid positron emission tomography (PET). If participants were confirmed to have reached these levels, they were able to complete treatment with Kisunla and switch to placebo for the remainder of the study.

Kisunla can cause amyloid-related imaging abnormalities (ARIA), which is a potential side effect with amyloid plaque-targeting therapies that does not usually cause symptoms. It can be detected via magnetic resonance imaging (MRI) scans and, when it does occur, may present as temporary swelling in an area or areas of the brain, which usually resolves over time, or as small spots of bleeding in or on the surface of the brain. Infrequently, larger areas of bleeding in the brain can occur.^1, 2 ARIA can be serious, and life-threatening events can occur. Kisunla can also cause certain types of allergic reactions, some of which may be serious and life-threatening, that typically occur during infusion or within 30 minutes post-infusion. Headache is another commonly reported side effect. See the Indication and Safety Summary with Warnings below for additional information. 

"This approval marks another step forward in evolving the standard of care for people living with Alzheimer's disease that will ultimately include an arsenal of novel treatments, providing much needed hope to the Alzheimer's community. As a physician, I am encouraged by the potential to stop treatment, which could reduce out-of-pocket costs and infusion burden for eligible patients," said Howard Fillit, M.D., Co-Founder and Chief Science Officer at the Alzheimer's Drug Discovery Foundation (ADDF). "Diagnosing and treating Alzheimer's sooner than we do today has the potential to meaningfully slow disease progression, giving patients invaluable time to maintain their independence for longer."

Cost and Coverage
In the TRAILBLAZER-ALZ 2 trial, people were able to complete treatment and switch to placebo at 6, 12, or 18 months after they achieved one of the study's treatment goals, minimal levels of amyloid plaque consistent with a visually negative amyloid PET scan. In the overall population of people receiving Kisunla, 17% completed treatment at 6 months, 47% at 12 months, and 69% at 18 months based on an assessment of amyloid levels via an amyloid PET scan.¹ 

Kisunla Limited-Duration Treatment Examples
Length of Treatment	6 months	12 months	18 months
30-Minute Infusions	6	13	19
Course of Therapy Cost	$12,522	$32,000	$48,696
Note: The price of each vial of Kisunla is $695.65.

The total cost of Kisunla will vary by patient based on when they complete treatment. The FDA's dosing instructions state that prescribers can consider stopping the dosing of Kisunla based on removal of amyloid plaques to minimal levels as observed on amyloid PET imaging. The potential to complete treatment after a limited-duration course of therapy, along with 30-minute infusions once per month, could result in lower patient out-of-pocket treatment costs and fewer infusions compared to other amyloid-targeting therapies.⁶ 

Patients' out-of-pocket cost for treatment with Kisunla will depend on their length of treatment and their insurance. Coverage and reimbursement for Kisunla are now available for eligible patients on Medicare under a National Coverage Determination with Coverage with Evidence Development. Also, as of October 2023, broad coverage and reimbursement for amyloid PET scans are available for eligible patients on Medicare. More than 98% of eligible Medicare patients have coverage that eliminates, limits, or caps their annual out-of-pocket exposure.¹⁵ 

Lilly Support Services for Kisunla is a free support program committed to helping patients navigate treatment with Kisunla. The program includes offerings such as coverage determination assistance, care coordination, nurse navigator support, and customized support and resources. For more information about Lilly Support Services and Kisunla, visit www.Kisunla.Lilly.com or call 1-800-LillyRx (1-800-545-5979).

Lilly Donating to Lilly Cares Foundation
Lilly intends to donate Kisunla to the Lilly Cares Foundation, a separate nonprofit organization that makes medicines available at no cost to qualified Americans, including some Medicare beneficiaries, who meet financial eligibility and other criteria. This is consistent with Lilly's long history of supporting access to our products to patients with financial need through medication donations to charitable organizations. Learn more about the Lilly Cares Foundation, including eligibility criteria, at www.lillycares.com. 

A media kit is available on Lilly.com with additional resources. 

About Kisunla™ (donanemab-azbt)
Kisunla™ (donanemab-azbt) (pronounced kih-SUHN-lah) is an amyloid-targeting treatment for people with mild cognitive impairment (MCI) as well as people with mild dementia stage of early symptomatic Alzheimer's disease, with confirmed amyloid pathology. Kisunla can cause serious side effects, including amyloid-related imaging abnormalities, or ARIA, and infusion-related reactions. Kisunla is a prescription medicine administered intravenously every four weeks, 700 mg for the first three doses and 1400 mg thereafter. 

About TRAILBLAZER-ALZ 2 Study and the TRAILBLAZER-ALZ program
TRAILBLAZER-ALZ 2 (NCT04437511) is a Phase 3, double-blind, placebo-controlled study to evaluate the safety and efficacy of donanemab in participants with early symptomatic Alzheimer's disease (MCI or mild dementia due to Alzheimer's disease) with the presence of confirmed Alzheimer's disease neuropathology. The trial enrolled 1,736 participants, across 8 countries, selected based on cognitive assessments in conjunction with evidence of Alzheimer's disease pathology. The Phase 3 TRAILBLAZER-ALZ 2 study results were published in the Journal of the American Medical Association (JAMA).

Lilly continues to study donanemab in multiple clinical trials, including TRAILBLAZER-ALZ 3, which is focused on preventing symptomatic Alzheimer's disease in participants with preclinical AD; TRAILBLAZER-ALZ 5, a registration trial for early symptomatic AD currently enrolling in China and Korea; and TRAILBLAZER-ALZ 6, which is focused on expanding our understanding of ARIA through novel MRI sequences, blood-based biomarkers, and different dosing regimens of donanemab.

INDICATION AND SAFETY SUMMARY WITH WARNINGS

Kisunla™ (kih-SUHN-lah) is used to treat adults with early symptomatic Alzheimer's disease (AD), which includes mild cognitive impairment (MCI) or mild dementia stage of disease.

Warnings - Kisunla can cause Amyloid-Related Imaging Abnormalities or "ARIA." This is a common side effect that does not usually cause any symptoms, but serious symptoms can occur. ARIA can be fatal. ARIA is most commonly seen as temporary swelling in an area or areas of the brain that usually goes away over time. Some people may also have spots of bleeding on the surface of or in the brain and infrequently, larger areas of bleeding in the brain can occur. Although most people do not have symptoms, some people have headache, dizziness, nausea, difficulty walking, confusion, vision changes, and seizures.

Some people have a genetic risk factor (homozygous apolipoprotein E ε4 gene carriers) that may cause an increased risk for ARIA. Talk to your healthcare provider about testing to see if you have this risk factor.

You may be at higher risk of developing bleeding in the brain if you take medicines to reduce blood clots from forming (antithrombotic medicines) while receiving Kisunla. Talk to your healthcare provider to see if you are on any medicines that increase this risk.

Your healthcare provider will do magnetic resonance imaging (MRI) brain scans before and during your treatment with Kisunla to check you for ARIA. You should carry information that you are receiving Kisunla, which can cause ARIA, and that ARIA symptoms can look like stroke symptoms. Call your healthcare provider or go to the nearest hospital emergency room right away if you have any of the symptoms listed above.

There are registries that collect information on treatments for Alzheimer's disease. Your healthcare provider can help you become enrolled in these registries.

Warnings - Kisunla can cause serious allergic and infusion-related reactions. Do not receive Kisunla if you have serious allergic reactions to donanemab-azbt or any of the ingredients in Kisunla. Symptoms may include swelling of the face, lips, mouth, or eyelids, problems breathing, hives, chills, irritation of skin, nausea, vomiting, sweating, headache, or chest pain. You will be monitored for at least 30 minutes after you receive Kisunla for any reaction. Tell your healthcare provider right away if you have these symptoms or any reaction during or after a Kisunla infusion.

Other common side effects

• Headache

Tell your healthcare provider right away if you have any side effects. These are not all of the possible side effects of Kisunla. You can report side effects at 1-800-FDA-1088 or www.fda.gov/medwatch.

Before you receive Kisunla, tell your healthcare provider:

• About all medicines you take, including prescription and over-the-counter medicines, as well as vitamins and herbal supplements. Especially tell your healthcare provider if you have medicines to reduce blood clots from forming (antithrombotic medicines, including aspirin).
• About all of your medical conditions including if you are pregnant, breastfeeding, or plan to become pregnant or breastfeed. Kisunla has not been studied in people who were pregnant or breastfeeding. It is not known if Kisunla could harm your unborn or breastfeeding baby.

How to receive Kisunla
Kisunla is a prescription medicine given through an intravenous (IV) infusion using a needle inserted into a vein in your arm. Kisunla is given once every 4 weeks. Each infusion will last about 30 minutes.

Learn more
For more information about Kisunla, call 1-800-LillyRx (1-800-545-5979) or go to kisunla.lilly.com.

This summary provides basic information about Kisunla. It does not include all information known about this medicine. Read the information given to you about Kisunla. This information does not take the place of talking with your healthcare provider. Be sure to talk to your healthcare provider about Kisunla. Your healthcare provider is the best person to help you decide if Kisunla is right for you. 

Please see full Prescribing Information including boxed warning for ARIA and Medication Guide for Kisunla.

DN CON BS APP

Kisunla™ and Lilly Support Services™ are  trademarks owned or licensed by Eli Lilly and Company, its subsidiaries, or affiliates.

About Lilly 
Lilly is a medicine company turning science into healing to make life better for people around the world. We've been pioneering life-changing discoveries for nearly 150 years, and today our medicines help more than 51 million people across the globe. Harnessing the power of biotechnology, chemistry and genetic medicine, our scientists are urgently advancing new discoveries to solve some of the world's most significant health challenges: redefining diabetes care; treating obesity and curtailing its most devastating long-term effects; advancing the fight against Alzheimer's disease; providing solutions to some of the most debilitating immune system disorders; and transforming the most difficult-to-treat cancers into manageable diseases. With each step toward a healthier world, we're motivated by one thing: making life better for millions more people. That includes delivering innovative clinical trials that reflect the diversity of our world and working to ensure our medicines are accessible and affordable. To learn more, visit Lilly.com and Lilly.com/news, or follow us on Facebook, Instagram and LinkedIn. P-LLY

PP-DN-US-0193 07/2024

© Lilly USA, LLC 2024. ALL RIGHTS RESERVED. 

Cautionary Statement Regarding Forward-Looking Statements
This press release contains forward-looking statements (as that term is defined in the Private Securities Litigation Reform Act of 1995) about Kisunla (donanemab-azbt) as a treatment for people with early symptomatic Alzheimer's disease, the supply and commercialization of Kisunla, and future readouts, presentations, and other milestones relating to Kisunla and reflects Lilly's current beliefs and expectations. However, as with any pharmaceutical product, there are substantial risks and uncertainties in the process of drug research, development, and commercialization. Among other things, there is no guarantee that planned or ongoing studies will be completed as planned, that future study results will be consistent with study findings to date, that Kisunla will receive additional regulatory approvals or that Kisunla will be commercially successful. For further discussion of these and other risks and uncertainties, see Lilly's Form 10-K and Form 10-Q filings with the United States Securities and Exchange Commission. Except as required by law, Lilly undertakes no duty to update forward-looking statements to reflect events after the date of this release.

References 

1. Kisunla (donanemab-azbt). Prescribing Information. Lilly USA, LLC. 
2. Kisunla (donanemab-azbt). Medication Guide. Lilly USA, LLC. 
3. Sims JR, Zimmer JA, Evans CD, et al. Donanemab in Early Symptomatic Alzheimer Disease: The TRAILBLAZER-ALZ 2 Randomized Clinical Trial. JAMA. 2023;330(6):512-527. doi:10.1001/jama.2023.13239.
4. Ross EL, Weinberg MS, Arnold SE. Cost-effectiveness of Aducanumab and Donanemab for Early Alzheimer Disease in the US. JAMA Neurol. 2022;79(5):478-487. doi:10.1001/jamaneurol.2022.0315.
5. Boustani M, Doty EG, Garrison LP Jr, et al. Assessing the Cost-effectiveness of a Hypothetical Disease-modifying Therapy With Limited Duration for the Treatment of Early Symptomatic Alzheimer Disease. Clin Ther. 2022;44(11):1449-1462. doi:10.1016/j.clinthera.2022.09.008.
6. Mattke S, Ozawa T and Hanson M. Implications of Treatment Duration and Intensity on the Value of Alzheimer's Treatments. Clinical Trials on Alzheimer's Disease. Oct. 24-27, 2023.
7. Porsteinsson AP, Isaacson RS, Knox S, et al. Diagnosis of early Alzheimer's disease: clinical practice in 2021. J Prev Alzheimers Dis. 2021;8:371-386.
8. Alzheimer's Association. 2023 Alzheimer's disease facts and figures. Alzheimers Dement. 2023;19(4):1598-1695 
9. Wessels AM, Dennehy EB, Dowsett SA, et al. Meaningful clinical changes in Alzheimer disease measured with the iADRS and illustrated using the donanemab TRAILBLAZER-ALZ study findings. Neurol Clin Pract. 2023;13(2):e200127. doi:10.1212/CPJ.0000000000200127
10. Bucci M, Chiotis K, Nordberg A; Alzheimer's Disease Neuroimaging Initiative. Alzheimer's disease profiled by fluid and imaging markers: tau PET best predicts cognitive decline. Mol Psychiatry. 2021 Oct;26(10):5888-5898. doi: 10.1038/s41380-021-01263-2.
11. Boccalini C, Ribaldi F, Hristovska I, Arnone A, Peretti DE, Mu L, Scheffler M, Perani D, Frisoni GB, Garibotto V. The impact of tau deposition and hypometabolism on cognitive impairment and longitudinal cognitive decline. Alzheimers Dement. 2023 Aug 9. doi: 10.1002/alz.13355.
12. Data on File. Lilly USA, LLC. DOF-DN-US-0053.
13. Data on File. Lilly USA, LLC. DOF-DN-US-0055.
14. Data on File. Lilly USA, LLC. DOF-DN-US-0029. 
15. Naber J. Alzheimer's disease: An analysis of the diagnosed population and out-of-pocket cost exposure. Milliman Brief. February 2024.

Refer to:	J.K. Wall; jkwall@lilly.com; 317-433-5328 (Media)
	Joe Fletcher; jfletcher@lilly.com; 317-296-2884 (Investors)

 

 

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FAQ

What is Kisunla (donanemab-azbt)?

Kisunla is Eli Lilly's newly FDA-approved treatment for early symptomatic Alzheimer's disease, including mild cognitive impairment and mild dementia with confirmed amyloid pathology.

How effective is Kisunla for Alzheimer's?

In a Phase 3 study, Kisunla slowed cognitive and functional decline by 35% and reduced the risk of disease progression by 39%.

How is Kisunla administered?

Kisunla is administered as a 30-minute intravenous infusion once a month.

What are the costs associated with Kisunla treatment?

The cost of Kisunla treatment can reach up to $48,696 for 18 months, depending on when the patient completes treatment.

Are there any risks associated with Kisunla?

Yes, Kisunla carries risks of amyloid-related imaging abnormalities (ARIA) and serious allergic reactions.

What is the market potential for Kisunla?

Kisunla has a significant market potential as it is the first amyloid plaque-targeting therapy with the option to stop treatment upon plaque removal, potentially lowering costs and infusion burden.