| The first therapies shown to slow Alzheimer’s disease – Kisunla from Eli Lilly and Leqembi from Biogen and Eisai – are set to become available in Taiwan in June. They’re the first new treatment option for the condition in 20 years. Yet local doctors caution that uncertainty around their long-term efficacy, safety risks, burdensome procedures and high costs mean patients and their families should think carefully before opting to take the drugs. Both Leqembi and Kisunla work by removing a protein from the brain that’s believed to cause the disease. With approvals in China, Japan, Korea and India, the drugs are slowly expanding their presence in Asia. In Taiwan, patients will have to pay out of pocket for the drugs, as they don’t currently qualify for reimbursement under the government health plan. And their price tags — $26,000 and $32,000 per year, respectively — are almost twice the median annual salary. Jong-Ling Fuh, attending physician at Taipei Veterans General Hospital, urges patients and their families to evaluate risks, quality of life and caregiving resources. The current clinical studies were only focused on patients with early-stage Alzheimer’s, and don’t yet show evidence the drugs can reverse memory decline or prolong life, she said in a public education statement. And initial study participants were mostly White, so it remains to be seen how the drugs will work for people of other ethnicities. Side effects should also be carefully monitored, including for brain swelling or bleeding, she said, which have resulted in deaths in the US. While calling the drugs “an important milestone,” Chaur-jong Hu, dean of Taipei Medical University’s College of Medicine, said they still have “many limitations.” For one, the treatment window is narrow as patients must start on the drugs while their cognitive impairment is still mild, he said. Not everyone knows the disease well enough to spot the symptoms early on. Some patients’ dementia signs take so long to diagnose that by the time they’re tested, it may already be too late. In clinical trials, Alzheimer’s patients who took the drugs saw their conditions worsen more slowly than those taking a placebo. Based on the results, Hu calculated that the medicines could delay dementia progression by four to five years, although “the actual experience or perceived treatment effect may vary.” The concerns echo similar ones voiced by neurologists in the US, where sluggish uptake has blunted blockbuster sales ambitions, and the UK, where the medicines won regulatory approval but were rejected for National Health Service coverage because the benefits were too small to justify the price. In Asian economies, most people rely on government-led insurance. So whether the treatments should be reimbursed by the government is likely to be a controversial topic, Da-Fu Chen, a neurologist at the National Taiwan University Hospital, said in a December lecture. Of the 350,000 people estimated to have dementia in Taiwan, experts expect 50,000 to be eligible for the treatments. Among them, 20,000 patients might be able to afford the drugs, according to United Daily News. It’s not just the drugs’ costs. Patients must also foot the bill for the expensive diagnostic tests required to determine eligibility for the Alzheimer’s treatments, such as PET scans and spinal taps. Once they start treatment, patients must visit clinics for injections every few weeks and get regular MRI follow-ups. That could take a physical and financial toll on caregivers, Fuh said. “Even if the medical requirements are met, the family support system should be considered,” Fuh said. — Amber Tong | 
