Leqembi launch hamstrung by physicians' 'therapeutic nihilism'

Eisai has recently outlined a range of ways to kick-start Leqembi’s lackluster launch, from increasing the number of neurology account specialists to adding a subcutaneous option. But a Reuters report suggests the company faces a more fundamental problem: Physicians still see Alzheimer’s disease as untreatable.

The Japanese drugmaker said 2,000 patients in the U.S. were receiving the amyloid-busting antibody as of Jan. 26, suggesting it will fall short of its goal of having 10,000 patients on Leqembi by the end of March. Eisai, which later dialed up its longer-term sales forecast, and its partner Biogen are working to address a range of issues they see as impediments to getting patients on Leqembi. 

Reuters spoke to 20 neurologists and geriatricians from rural, urban, academic and community practices in 19 states to understand what factors are bunging up the patient pipeline. The talks suggest that, in addition to the expected challenges, Eisai and Biogen still need to convince physicians about Leqembi.

Seven doctors treating patients for Alzheimer's said they are reluctant to prescribe Leqembi because of doubts about the drug's efficacy, cost and risks. James Burke, M.D., a neurologist at The Ohio State University, gave a blunt assessment, saying, “I don't think it's a good Alzheimer's drug.” Another six scientists said a belief that Alzheimer's is untreatable is more widespread among physicians than expected.  

Alex Scott, Eisai's chief administrative officer, is aware of the skepticism of physicians but said the teams “are beginning to make more and more progress every single month.” The hesitancy could be a hangover of decades of failure in Alzheimer’s but may also reflect misgivings about the data on Leqembi. While the antibody ended the phase 3 losing streak, some doctors doubt the results are clinically meaningful. 

“If we take the trial result at face value, the differences between placebo and treatment are likely small enough as to be undetectable by patients and family members or physicians,” Michael Greicius, M.D., a professor at Stanford University's Center for Memory Disorders, said. Greicius doesn’t recommend Leqembi to patients.

The skepticism expressed to Reuters sounds similar to the findings of a recent report by Spherix, which found few of the 75 surveyed U.S. neurologists “consider Leqembi to be a significant medical advance over other historical AD treatments.” Less than half of the neurologists were actively recommending the drug to patients.

Together, the Reuters and Spherix reports suggest that Eisai and Biogen need to win round physicians as well as fix issues related to coverage, testing and other factors that could limit uptake. In the absence of new data to convince the skeptics, sales and marketing will carry the weight of changing the narrative. Eisai recently supported the creation of a podcast miniseries about Alzheimer’s.