Q&A: Cost is largest ‘roadblock’ to lecanemab treatment for Alzheimer’s

Key takeaways:

• The largest challenge to prescribing lecanemab for Alzheimer’s is a yearly cost of $90K.
• A team of health care professionals is required to assist patients with lecanemab.

The FDA recently approved injectable Kisunla to treat early-stage Alzheimer’s disease, joining Leqembi, which gained FDA approval in July 2023 for the same purpose.

However, several challenges remain inherent with prescription and administration of both therapies.

Healio spoke to Nikhil Palekar, MD, associate professor and director of the Center of Excellence for Alzheimer’s Disease at Stony Brook Medicine, who offered his take on the future of Alzheimer’s treatment including Kisunla (donanemab-azbt, Eli Lilly & Co.) and Leqembi (lecanemab, Eisai).

Healio: Can you briefly describe the challenges related to lecanemab treatment as you first encountered them at Stony Brook.

Palekar: Lecanemab is the first anti-amyloid antibody treatment to receive full FDA approval for treatment of early-stage Alzheimer's disease. The medication costs $26,500 per year and total yearly cost of treatment is around $90,000 (including PET scan, MRIs, infusion costs).

The biggest challenge was the prolonged wait until CMS approved coverage for the treatments. Being a biweekly intravenous infusion which takes an hour to administer, an infusion center is needed to provide this medication. Every eligible patient with early-stage AD needs a comprehensive assessment involving amyloid PET scan, MRI, APOE genetic testing as well as neurocognitive and functional assessments which are then submitted into an online registry for approval to receive the medication following which a prior authorization is required through the patient’s insurance to administer this medication. We had to develop policies and procedures to ensure safe administration of the medication.

Healio: How did you overcome these roadblocks to successful treatment to gain the trust of this patient population?

Palekar: We developed a multidisciplinary group spanning various departments (pharmacy, infusion center, radiology, case management) to collaborate and communicate the protocol for administering Lecanemab. This teamwork was essential to address any roadblocks and create efficient workflows for successful medication administration.

Healio: With the recent FDA approval of Kisunla for early symptomatic Alzheimer’s disease, do you anticipate a rise in the number of patients asking for the treatment, and if so, how do you plan to accommodate the increased demand?

Palekar: We do anticipate an increase in patients requesting information and treatment with Kisunla. We have assigned additional resources such as care management staff, social workers and clinicians (NPs and physicians) to meet these demands. We also have plans to expand our infusion center capacity if needed.

Healio: As lecanemab and donanemab are approved treatments, how do you plan to inform and counsel your patients who may have trouble choosing what’s right for them?

Palekar: The indication for these medications is the same, ie for patients with early-stage AD. They also have similar inclusion and exclusion criteria. We plan to provide information regarding the efficacy and safety of both medications to eligible patients, discuss risks and benefits of both treatments and help patients and families decide which medications would be most appropriate for them.

Healio: Do you view approvals of lecanemab and donanemab as a positive and altruistic result of competitive practices to produce novel treatments for Alzheimer’s disease?

Palekar: These approvals are a positive step in the right direction. Although the benefits of slowing progression of symptoms is modest, it is better than our current treatment options. The success of these two medications will spur the development of more effective treatments in the near future and target other key pathological features such as tau tangles and neuroinflammation.