Alzheimer’s drug adoption in US slowed by doctors’ skepticism
CHICAGO, Illinois: Nearly nine months into the U.S. launch of Eisai and Biogen’s Leqembi, the first drug proven to slow Alzheimer’s progression, it faces an unexpected barrier to widespread use: skepticism among some doctors regarding the treatment’s efficacy. While Alzheimer’s experts foresaw challenges due to Leqembi’s requirements-such as additional diagnostic tests, twice-monthly infusions, and regular brain scans to monitor side effects-the drug’s adoption has been sluggish since its FDA approval. Interviews with 20 neurologists and geriatricians across various practice settings in 19 states reveal concerns about efficacy, cost, and risks hindering prescription rates. Dr. James Burke of Ohio State University doubted Leqembi’s effectiveness, stating, "I don’t think it is a good Alzheimer’s drug. I think that is the problem." "It is certainly nothing like the home run that we are looking for." Other experts noted the prevalence of "therapeutic nihilism"-a belief that Alzheimer’s treatment is futile-among primary care doctors, geriatricians, and neurologists, further dampening demand. Dr. Reisa Sperling, a neurologist and Alzheimer’s researcher at Mass General Brigham in Boston, likens some doctors’ skepticism to Leqembi to fatalistic attitudes about cancer treatment 30 years ago: "You can’t really do anything about it, so why would you even want to get tested?" Alex Scott, Eisai’s chief administrative officer, acknowledged skepticism’s impact on the drug’s launch, attributing some hesitancy to long-standing doubts about amyloid-targeting treatments. He emphasized ongoing progress and the need for time for providers to adjust to the new treatment paradigm. "We are beginning to make more and more progress every single month. So we are still quite encouraged," Scott said. "This is a new journey, and I think it takes some time for providers to figure it out." Despite Leqembi’s efficacy in slowing cognitive decline, concerns about its clinical significance and cost-effectiveness linger. Dr. Michael Greicius of Stanford University questioned the drug’s tangible benefits, cautioning against its widespread adoption based on modest trial results. Other doctors have raised concerns about the risk of brain swelling and bleeding associated with Leqembi as well as the costs associated with the $26,500 annual drug, frequent MRIs and twice-monthly infusions. "There are significant risks associated with these drugs, there are significant costs, and I would say there is marginal benefit," said Dr. Eric Widera, a geriatrician and professor at the University of California San Francisco, referring to amyloid-lowering treatments. Dr. Jonathan Liss, a neurologist and Leqembi researcher, emphasized combating nihilism in Alzheimer’s treatment, likening it to past attitudes toward cancer care. Dr. Nathaniel Chin of the University of Wisconsin stressed the ethical dilemma of withholding an FDA-approved treatment, even with limited evidence of efficacy. Biogen’s executive vice president, Dr. Priya Singhal, acknowledged physician apathy but identified infrastructure and access barriers as more pressing issues. Biogen and Eisai actively engage with advocacy groups and develop educational initiatives to address these concerns. While Leqembi remains the sole Alzheimer’s drug designed to slow disease progression, skepticism persists among physicians, even as patients like Lyn Castellano find hope in the treatment. Dr. Suzanne Schindler, an Alzheimer’s researcher treating Castellano, said Leqembi "forces clinicians to completely change the way they have practiced medicine for many years." Despite uncertainty about its effectiveness, Castellano says the treatment has given her hope, and she doesn’t mind the twice-monthly infusions. "I get to go, sit back in a nice chair, have my dog with me and read a book for a couple hours. It is about the only place I get some peace and quiet."