WASHINGTON — U.S. officials granted full approval to a closely watched Alzheimer’s drug on Thursday, clearing the way for Medicare and other insurance plans to begin covering the treatment for people with the brain-robbing disease.
The Food and Drug Administration endorsed the IV drug, Leqembi, for patients with mild dementia and other symptoms caused by early Alzheimer’s disease. It’s the first medicine that’s been convincingly shown to modestly slow Alzheimer’s cognitive decline.
Japanese drugmaker Eisai received conditional approval from the FDA in January based on early results suggesting Leqembi worked by clearing a sticky brain plaque linked to the disease.
The FDA confirmed those results by reviewing data from a larger, 1,800-patient study in which the drug slowed memory and thinking decline by about five months in those who got the treatment, compared to those who got a dummy drug.
“This confirmatory study verified that it is a safe and effective treatment for patients with Alzheimer’s disease,” said FDA’s neurology drug director, Teresa Buracchio, in a statement.
The drug’s prescribing information will carry the most serious type of warning, indicating that Leqembi can cause brain swelling and bleeding, side effects that can be dangerous in rare cases. The label notes that those problems are seen with other plaque-targeting Alzheimer’s drugs.
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FILE - This image provided by Eisai in January 2023 shows vials and packaging for their medication, Leqembi. On Thursday, July 6, 2023, U.S. officials granted full approval to the closely watched Alzheimer’s drug, clearing the way for Medicare and other insurance plans to begin covering the treatment for people with the brain-robbing disease. (Eisai via AP, File)
The process of converting a drug to full FDA approval usually attracts little attention. But Alzheimer’s patients and advocates have been lobbying the federal government for months after Medicare officials announced last year they wouldn’t pay for routine use of Leqembi until it received FDA’s full approval.
There were concerns that the cost of new plaque-targeting Alzheimer’s drugs like Leqembi could overwhelm the program’s finances, which provide care for 60 million seniors. Leqembi is priced at about $26,500 for a year’s supply of IVs every two weeks.
The vast majority of Americans with Alzheimer’s get their health coverage through Medicare. And private insurers have followed its lead by withholding coverage for Leqembi and a similar drug, Aduhelm, until they receive FDA’s full endorsement. An FDA decision on full approval for Aduhelm is still years away.
Medicare administrator, Chiquita Brooks-LaSure, has made clear the program will immediately begin paying for the drug now that it has full FDA approval. But the government is also setting extra requirements.
Medicare recipients getting Leqembi must be enrolled in a federal registry to track the drug’s real-world safety and effectiveness. The information will help advance “knowledge of how these drugs can potentially help people,” Medicare officials said.
Hospitals and medical clinics have also cautioned that it may take time to get people started on the drug.
Doctors need to confirm that patients have the brain plaque targeted by Leqembi before prescribing it. Nurses need to be trained to administer the drug and patients must be monitored with repeated brain scans to check for swelling or bleeding. The imaging and administration services carry extra costs for hospitals beyond the drug itself.
Eisai has told investors that about 100,000 Americans could be diagnosed and eligible to receive Leqembi by 2026. The drug is co-marketed with Cambridge, Massachusetts-based Biogen.
“We want to ensure that appropriate patients only are the ones that get this product,” said Alexander Scott, a vice president with Eisai.
Eisai studied the drug in people with early or mild disease who were evaluated using a scale measuring memory, thinking and other basic skills. After 18 months, those who got Leqembi declined more slowly — a difference of less than half a point on the scale — than participants who received a dummy infusion. Some Alzheimer’s experts say that delay is likely too subtle for patients or their families to notice.
But federal health advisers said the difference could still be meaningful and recommended that FDA fully approve the drug at a public meeting in June.
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Nasal vaccine for Alzheimer’s disease tested in first human trial
shurkin_son // Shutterstock
According to The Centers for Disease Control and Prevention (CDC), “Dementia is not a specific disease, but is rather a general term for the impaired ability to remember, think, or make decisions that interfere with doing everyday activities.” The most common type of dementia is Alzheimer’s disease, though there are several types of dementia including frontotemporal dementia (FTD), dementia with Lewy bodies (DLB), and vascular dementia (VaD) to name a few. Globally, more than 50 million people have dementia, and an estimated 10 million new cases are reported each year. Projections show that the number of affected individuals will reach 82 million in 2030 and 152 million by 2050.
A dementia diagnosis comes after a series of tests of memory, problem-solving, and other cognitive abilities performed by a health care provider. Blood tests, brain scans, and physicals are carried out to help doctors figure out the underlying cause. Dementia is broken down into early, mid, and late stages, with a worsening of symptoms as the condition progresses.
The long-term effects of dementia can be difficult for both those affected and their caregivers, family, and friends, and can include a lack of family recognition, difficulty walking, and significant memory impairment. The afflicted person becomes completely dependent on others for care. Early diagnosis is especially important and can help with planning both at home, with preventive care and other measures such as reminders, and at work. It also enables dementia patients to access clinical trials and available therapies that may improve cognitive functioning and overall quality of life.
Neural Effects consulted the CDC’s list of warning signs for dementia and Alzheimer’s disease to review what adults should look for before seeking an official medical diagnosis. This list may also prove helpful for those who’ve noticed loved ones who are experiencing one or more early signs of dementia.
shurkin_son // Shutterstock
According to The Centers for Disease Control and Prevention (CDC), “Dementia is not a specific disease, but is rather a general term for the impaired ability to remember, think, or make decisions that interfere with doing everyday activities.” The most common type of dementia is Alzheimer’s disease, though there are several types of dementia including frontotemporal dementia (FTD), dementia with Lewy bodies (DLB), and vascular dementia (VaD) to name a few. Globally, more than 50 million people have dementia, and an estimated 10 million new cases are reported each year. Projections show that the number of affected individuals will reach 82 million in 2030 and 152 million by 2050.
A dementia diagnosis comes after a series of tests of memory, problem-solving, and other cognitive abilities performed by a health care provider. Blood tests, brain scans, and physicals are carried out to help doctors figure out the underlying cause. Dementia is broken down into early, mid, and late stages, with a worsening of symptoms as the condition progresses.
The long-term effects of dementia can be difficult for both those affected and their caregivers, family, and friends, and can include a lack of family recognition, difficulty walking, and significant memory impairment. The afflicted person becomes completely dependent on others for care. Early diagnosis is especially important and can help with planning both at home, with preventive care and other measures such as reminders, and at work. It also enables dementia patients to access clinical trials and available therapies that may improve cognitive functioning and overall quality of life.
Neural Effects consulted the CDC’s list of warning signs for dementia and Alzheimer’s disease to review what adults should look for before seeking an official medical diagnosis. This list may also prove helpful for those who’ve noticed loved ones who are experiencing one or more early signs of dementia.
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Nasal vaccine for Alzheimer’s disease tested in first human trial
LightField Studios // Shutterstock
Forgetting recently learned information is one of the earliest signs of dementia. Name recall, as well as remembering important dates and events, becomes difficult for people in the early stages of dementia. Often they need to rely on memory aids, like wall calendars, sticky notes, digital reminders, or help from family members for things like taking medications at the correct time and arriving on the right date to appointments. Asking the same question several times or repeating stories is very common. While this sign is seen often in dementia, it is also a typical sign of aging as well as mild cognitive impairment, which can be, but is not always, an early warning indicator of Alzheimer’s disease. Memory loss may also be a sign of depression; B12 deficiency; kidney, brain, thyroid, or liver disorders; or a side effect of certain medications.
LightField Studios // Shutterstock
Forgetting recently learned information is one of the earliest signs of dementia. Name recall, as well as remembering important dates and events, becomes difficult for people in the early stages of dementia. Often they need to rely on memory aids, like wall calendars, sticky notes, digital reminders, or help from family members for things like taking medications at the correct time and arriving on the right date to appointments. Asking the same question several times or repeating stories is very common. While this sign is seen often in dementia, it is also a typical sign of aging as well as mild cognitive impairment, which can be, but is not always, an early warning indicator of Alzheimer’s disease. Memory loss may also be a sign of depression; B12 deficiency; kidney, brain, thyroid, or liver disorders; or a side effect of certain medications.
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Nasal vaccine for Alzheimer’s disease tested in first human trial
Phase4Studios // Shutterstock
An occasional mix-up while balancing a checkbook can be a common sign of aging. Losing track of monthly bills can be a more serious sign. An inability to concentrate or difficulty following a familiar recipe may warrant a doctor’s visit. Planning may become almost impossible for those in the earliest stages of dementia and indicates a deficit in executive functioning. Difficulties with problem-solving can also signal other health issues ranging from serious conditions like a brain tumor to less insidious conditions such as stress.
Phase4Studios // Shutterstock
An occasional mix-up while balancing a checkbook can be a common sign of aging. Losing track of monthly bills can be a more serious sign. An inability to concentrate or difficulty following a familiar recipe may warrant a doctor’s visit. Planning may become almost impossible for those in the earliest stages of dementia and indicates a deficit in executive functioning. Difficulties with problem-solving can also signal other health issues ranging from serious conditions like a brain tumor to less insidious conditions such as stress.
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Nasal vaccine for Alzheimer’s disease tested in first human trial
Monkey Business Images // Shutterstock
Often in early dementia, the simplest tasks become increasingly difficult. While older people may have trouble with operating a computer or the settings on a television remote—and this can be a normal symptom of aging—those with dementia can’t perform daily tasks that were once a part of their routine. Getting dressed can become a major undertaking. The real difficulty actually comes with the sequence or order of doing things. Writing out the steps to tasks such as preparing a meal and leaving them in easily accessible places can be helpful.
Monkey Business Images // Shutterstock
Often in early dementia, the simplest tasks become increasingly difficult. While older people may have trouble with operating a computer or the settings on a television remote—and this can be a normal symptom of aging—those with dementia can’t perform daily tasks that were once a part of their routine. Getting dressed can become a major undertaking. The real difficulty actually comes with the sequence or order of doing things. Writing out the steps to tasks such as preparing a meal and leaving them in easily accessible places can be helpful.
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Nasal vaccine for Alzheimer’s disease tested in first human trial
Jacob L. // Shutterstock
Often people in the early stages of dementia forget the time and even lose track of months and seasons. While many retired people may forget what day it is because they no longer go to work and live by a calendar, the sort of confusion surrounding time is much more severe in those with dementia. Losing track of where they are or how they got to certain places is common and should be investigated by a doctor. This type of confusion may be acute and occur suddenly or may happen over time. Those afflicted will often experience periods of confusion surrounding time and place and then revert to their old selves. Perception of time and time distortion are also issues for those struggling with dementia. They may believe they haven’t seen a loved one for months or years, when in fact it was only days ago.
Jacob L. // Shutterstock
Often people in the early stages of dementia forget the time and even lose track of months and seasons. While many retired people may forget what day it is because they no longer go to work and live by a calendar, the sort of confusion surrounding time is much more severe in those with dementia. Losing track of where they are or how they got to certain places is common and should be investigated by a doctor. This type of confusion may be acute and occur suddenly or may happen over time. Those afflicted will often experience periods of confusion surrounding time and place and then revert to their old selves. Perception of time and time distortion are also issues for those struggling with dementia. They may believe they haven’t seen a loved one for months or years, when in fact it was only days ago.
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Nasal vaccine for Alzheimer’s disease tested in first human trial
photo8313 // Shutterstock
Difficulty understanding visual images and spatial relations can impact depth perception, which can cause an increased risk of falling and can make feeding and bathing more challenging. Driving difficulty due to problems with spatial relations is quite common, and navigating turns and changing lanes can become dangerous. Often people with dementia are forced to give up driving. Reading also becomes a problem, not only because of the visuospatial issues, but also due to an inability to understand words. A 2016 study of visuospatial skills in dementia patients found that those with certain types of dementia, including Alzheimer’s disease, dementia of Lewy bodies, and vascular dementia, performed poorly in comparison to controls when examining space and object perception. The study found that significant impairment of visuospatial functions occurs in the early stages of dementia and worsens as the disease progresses.
photo8313 // Shutterstock
Difficulty understanding visual images and spatial relations can impact depth perception, which can cause an increased risk of falling and can make feeding and bathing more challenging. Driving difficulty due to problems with spatial relations is quite common, and navigating turns and changing lanes can become dangerous. Often people with dementia are forced to give up driving. Reading also becomes a problem, not only because of the visuospatial issues, but also due to an inability to understand words. A 2016 study of visuospatial skills in dementia patients found that those with certain types of dementia, including Alzheimer’s disease, dementia of Lewy bodies, and vascular dementia, performed poorly in comparison to controls when examining space and object perception. The study found that significant impairment of visuospatial functions occurs in the early stages of dementia and worsens as the disease progresses.
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Nasal vaccine for Alzheimer’s disease tested in first human trial
wavebreakmedia // Shutterstock
While aging can cause an occasional problem with finding the right word, communication issues are much more significant in the early stages of dementia. Following conversations and finding the correct words for objects is difficult for those with dementia, and this early warning sign should be brought to a doctor’s attention. Aphasia, a type of language disorder, impacts communication including speech, writing, and language comprehension. According to the Mayo Clinic, “Primary progressive aphasia is a type of frontotemporal dementia.” Of course, there are other medical conditions that can cause language and communication issues including strokes, brain tumors, and brain injuries.
wavebreakmedia // Shutterstock
While aging can cause an occasional problem with finding the right word, communication issues are much more significant in the early stages of dementia. Following conversations and finding the correct words for objects is difficult for those with dementia, and this early warning sign should be brought to a doctor’s attention. Aphasia, a type of language disorder, impacts communication including speech, writing, and language comprehension. According to the Mayo Clinic, “Primary progressive aphasia is a type of frontotemporal dementia.” Of course, there are other medical conditions that can cause language and communication issues including strokes, brain tumors, and brain injuries.
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Nasal vaccine for Alzheimer’s disease tested in first human trial
CGN089 // Shutterstock
Misplacing things could mean putting objects in strange places, like placing car keys in the microwave, and it is a common sign of dementia. Those struggling may also have difficulty in retracing their steps to find the things they’ve lost. This lack of ability to retrace steps differentiates this as a sign of dementia versus a normal sign of aging. It can be both dangerous and frustrating. As the disease progresses, the afflicted person may accuse others of stealing things that have been misplaced.
CGN089 // Shutterstock
Misplacing things could mean putting objects in strange places, like placing car keys in the microwave, and it is a common sign of dementia. Those struggling may also have difficulty in retracing their steps to find the things they’ve lost. This lack of ability to retrace steps differentiates this as a sign of dementia versus a normal sign of aging. It can be both dangerous and frustrating. As the disease progresses, the afflicted person may accuse others of stealing things that have been misplaced.
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Nasal vaccine for Alzheimer’s disease tested in first human trial
Monkey Business Images // Shutterstock
During the early stages of dementia, decision-making is impacted and can cause poor judgment. People may spend money foolishly or have a hard time remembering to feed and walk a pet. They may also pay less attention to grooming and personal hygiene. Those struggling with dementia are especially susceptible to scams involving money. One poor decision should not be considered an indicator of dementia though. Instead, look for a pattern which might include things like constantly wearing summer dresses even though it’s winter, or walking in a busy area and not paying attention to traffic lights.
Monkey Business Images // Shutterstock
During the early stages of dementia, decision-making is impacted and can cause poor judgment. People may spend money foolishly or have a hard time remembering to feed and walk a pet. They may also pay less attention to grooming and personal hygiene. Those struggling with dementia are especially susceptible to scams involving money. One poor decision should not be considered an indicator of dementia though. Instead, look for a pattern which might include things like constantly wearing summer dresses even though it’s winter, or walking in a busy area and not paying attention to traffic lights.
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Nasal vaccine for Alzheimer’s disease tested in first human trial
Nikodash // Shutterstock
Not wanting to participate in social activities once enjoyed, like golf or going to church, may be a sign of dementia. Because of an inability to follow conversations or participate in hobbies and comprehend them in a familiar way, things like watching a favorite sport or going to family dinners might become less enjoyable. This may cause people with dementia to withdraw. They may sleep more frequently or spend more time sitting in front of the television. Social withdrawal could also be a symptom of depression, anxiety, or post-traumatic stress disorder.
Nikodash // Shutterstock
Not wanting to participate in social activities once enjoyed, like golf or going to church, may be a sign of dementia. Because of an inability to follow conversations or participate in hobbies and comprehend them in a familiar way, things like watching a favorite sport or going to family dinners might become less enjoyable. This may cause people with dementia to withdraw. They may sleep more frequently or spend more time sitting in front of the television. Social withdrawal could also be a symptom of depression, anxiety, or post-traumatic stress disorder.
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Nasal vaccine for Alzheimer’s disease tested in first human trial
Monkey Business Images // Shutterstock
While being sad or experiencing a shift in mood can happen to almost anyone occasionally, mood and personality changes may be early indicators of serious health issues. These can include mental health conditions, hormonal changes, or substance abuse problems. When those with dementia experience these symptoms, they can manifest as fear, suspicion, and getting easily upset or becoming irritable over minor things. Things that never would have bothered them before often will now. They may also lose patience more quickly. The National Institute on Aging recommends doing several things to help navigate these changes in mood and personality, including having a daily routine and using humor when appropriate.
This story originally appeared on Neural Effects and was produced and distributed in partnership with Stacker Studio.
Monkey Business Images // Shutterstock
While being sad or experiencing a shift in mood can happen to almost anyone occasionally, mood and personality changes may be early indicators of serious health issues. These can include mental health conditions, hormonal changes, or substance abuse problems. When those with dementia experience these symptoms, they can manifest as fear, suspicion, and getting easily upset or becoming irritable over minor things. Things that never would have bothered them before often will now. They may also lose patience more quickly. The National Institute on Aging recommends doing several things to help navigate these changes in mood and personality, including having a daily routine and using humor when appropriate.
This story originally appeared on Neural Effects and was produced and distributed in partnership with Stacker Studio.
