Written by Alius Noreika
Nine months after its introduction in the U.S., Eisai and Biogen's Alzheimer's drug Leqembi is encountering significant resistance in its widespread adoption, largely due to skepticism among some doctors about the efficacy of treating this degenerative brain disease.
Preparation for an MRI scan – illustrative photo. Image credit: Accuray via Unsplash, free license
Despite being the first drug proven to slow the progression of Alzheimer's, entrenched doubts among healthcare providers about the value of treating the condition are proving to be a major obstacle.
Alzheimer's specialists initially expected challenges related to Leqembi's demanding protocol, which includes additional diagnostic tests, bi-monthly infusions, and regular brain scans to monitor for potentially severe side effects. Indeed, these requirements have contributed to the drug's slow uptake since its approval by the U.S. Food and Drug Administration, as evidenced by discussions with 20 neurologists and geriatricians across various U.S. regions.
According to Reuters, seven doctors disclosed their hesitancy to prescribe Leqembi, citing doubts about the drug's effectiveness, its cost, and its associated risks. Moreover, a group of six leading experts in the field indicated that “therapeutic nihilism” – the perception that Alzheimer's is an insurmountable condition – is having a more significant impact than expected in limiting enthusiasm among primary care doctors, geriatricians, and neurologists. This skepticism is affecting their willingness to refer patients to memory specialists for potential treatment with Leqembi.
Some experts say that the reluctance among some doctors might stem from the lengthy period of doubt that clouded the efficacy of targeting the Alzheimer's protein beta amyloid to slow the disease's progression. Prior to the encouraging outcomes of the Leqembi trial, many in the medical field considered this research direction unfruitful.
Concerns have been raised by other medical professionals regarding the side effects of Leqembi, such as brain swelling and bleeding, in addition to the costs involved with the $26,500 annual price tag, frequent MRIs, and bi-monthly infusions.
Leqembi was the first amyloid-targeting drug to receive full FDA approval after demonstrating a 27% slowdown in cognitive decline among early-stage Alzheimer's patients during clinical trials. Despite the initial goal to treat 10,000 Americans by the end of March, only a few thousand had started treatment by the end of January, as reported by Eisai, whose spokeswoman declined to provide updated figures.
The adoption of new drugs, even those not requiring significant changes in medical practice, is infamously slow. Research has shown that it can take an average of 17 years for clinical research to become routine practice. Alzheimer's affects over 6 million Americans, yet fewer than half of U.S. neurologists are recommending Leqembi to their patients, as per a January survey by life sciences market researcher Spherix Global Insights.