In May 2025, The Therapeutic Goods Administration approved Donanemab (brand Kisunla) for Mild Cognitive Impairment and Early Alzheimer's Disease.

This is given as an infusion once every four weeks to suitable patients. Each infusion is likely to cost around $4700, at this stage up to 18 months of therapy is advised, unless amyloid levels fall dramatically after 6 months. The cost and associated costs are not covered by PBS, Private health insurance or Medicare.

Patients and their families should understand:

The treatment slows but does not stop or reverse the progression of the disease.

It is complemented by other treatments such as exercise and other brain health measures, they should continue.

Common side effects include some unpleasant infusion reactions.

Uncommon but serious side effects include swelling and bleeding on the brain. These can require treatment to stop, they can cause temporary or permanent worsening of cognition, disability or death. Regular MRIs are scheduled to check for this, but patients must be observed and assessment sought in between.

It is too dangerous to give patients with a certain set of genes for Alzheimer's (ApoE4)

Suitable patients:

Have mild illness (MMSE ≥ 20/30)

Have had an MRI that shows little vascular change and little risk for bleeding on the brain, and can have an MRI after the second, third, fourth and seventh infusions.

Have had a test to confirm amyloid in the brain; either cerebrospinal fluid from a lumbar puncture, certain blood tests or scans.

Have had a blood test to check for ApoE genes (double copies -homozygotes- of ApoE4 are not suitable for Kisunla)

Have been checked carefully for any other cause.

Have private health insurance to cover hospital admissions, and can cover the cost of MRIs and the medicine itself (not covered by private health).

I do offer assessment for and treatment of suitable patients with Donanemab. Make an appointment to discuss.