The first drug to slow Alzheimer’s disease already exists, but why are doctors skeptical?

Nine months after its introduction in the United States, Eisai and Biogen’s Alzheimer’s drug, Leqembi, is encountering significant resistance to its widespread adoption, largely due to skepticism among some doctors about the effectiveness treatment of this degenerative brain disease.

Preparing for an MRI – illustrative photo. Image credit: Accuray via Unsplash, free license

Although it was the first drug proven to slow the progression of Alzheimer’s disease, deep-seated doubts among health care providers about the usefulness of treating the disease s prove to be a major obstacle.

Alzheimer’s disease specialists initially expected difficulties with Leqembi’s demanding protocol, which includes additional diagnostic tests, biweekly infusions and regular brain scans to monitor for potentially serious side effects. Indeed, these requirements have contributed to the drug’s slow adoption since its approval by the U.S. Food and Drug Administration, as evidenced in discussions with 20 neurologists and geriatricians in various regions of the United States.

According to Reuters, seven doctors expressed hesitancy to prescribe Leqembi, citing doubts about the drug’s effectiveness, its cost and associated risks. Additionally, a group of six leading experts in the field reported that “therapeutic nihilism” – the perception that Alzheimer’s disease is an intractable disease – is having a greater impact than expected in limiting the enthusiasm of doctors for primary care, geriatricians and neurologists. This skepticism affects their willingness to refer patients to memory specialists for possible treatment with Leqembi.

Some experts say the reluctance of some doctors may stem from the long period of doubt that has clouded the effectiveness of targeting Alzheimer’s disease’s amyloid-beta protein in slowing the progression of the disease. Prior to the encouraging results of the Leqembi trial, many in the medical field considered this research direction unsuccessful.

Concerns have been raised by other medical professionals about Leqembi’s side effects, such as brain swelling and bleeding, in addition to the costs associated with the $26,500 annual price, frequent MRIs and biweekly infusions. .

Leqembi was the first amyloid-targeting drug to receive full FDA approval after demonstrating a 27% slowing of cognitive decline in patients with early-stage Alzheimer’s disease during clinical trials. Despite the initial goal of treating 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 numbers.

Adoption of new drugs, even those that do not require significant changes in medical practice, is depressingly slow. Research has shown that it takes an average of 17 years for clinical research to become standard practice. Alzheimer’s disease affects more than 6 million Americans, but fewer than half of U.S. neurologists recommend Leqembi to their patients, according to a January survey by life sciences specialist Spherix Global Insights.