A newly-approved Alzheimer's drug could help tens of thousands of Australians with the condition, but most people won't have access to the "incredibly important" medicine.
Lacenamab, which has the brand name Leqembi, has been approved by the Therapeutic Goods Administration (TGA) for use by some patients with mild cognitive impairment.
It is shown to reduce a plaque in the brain called amyloid, which contributes to Alzheimer's symptoms, but carries a minor risk of swelling or bleeding on the brain.
There are about 425,000 people in Australia living with dementia, according to the Australian Institute of Health and Welfare (AIHW), which the degenerative brain disease, Alzheimer's disease, being the most common form.
'Shattered' by diagnosis
Retired police officer Peter Duclos was diagnosed with the condition in 2024.
"I felt things weren't quite right … I was forgetful and just wasn't feeling like me," he told SBS News.
"I used to love photography, but now I've lost those skills.
"You think you're great one day and then the next day you think: 'oh God, how do I do this again?'"
After seeing his GP and getting several scans, he was given his diagnosis of younger-onset Alzheimer’s disease.
He felt "shattered" and reached out to peak advocacy group Dementia Australia for support.
After taking a course with the group, he started volunteering as a peer support person for other people living with Alzheimer's and dementia.
He said the approval of lecanemeb could help many people with the illness, but it's too late for him.
"I might be a bit further along with it [Alzheimer's] that can be beneficial for me now," he said.
Peter Duclos lives on Sydney's northern beaches with family. Source: Supplied / Peter Duclos.
Lecanemab has an estimated cost of $40,000 for a treatment cycle of between 12 and 18 months.
Additional health costs will take the price per patient up to around $80,000 to $100,000, depending on individual needs.
The drug's cost could be decreased if the government decides to subsidise it through the Pharmaceutical Benefits Scheme (PBS); however, it has not placed donanemab (sold as Kisunla), a comparable Alzheimer's drug approved earlier this year, on the scheme.
'Well-deserved' approval
Christopher Rowe, the director of the Australian Dementia Network, said the approval of lecanemab as a treatment is "well deserved", after its parent company failed twice to get the green light from the TGA.
"It's third time lucky and Australia is a little late to the party. It's already been approved in 51 countries. So I'm glad to see it finally happened here," he told SBS News.
"The fact that they approved donanemab, which has very similar effectiveness and side effects to lecanemab, could have impacted their decision."
In a statement released this week, the TGA said the Japanese drug manufacturer Eisai Australia has "satisfactorily addressed the outstanding concerns regarding the safety of the medicine".
There have been concerns that the drug can have fatal consequences in around 0.6 per cent of people, as shown in a long-running UK trial of lecanemeb.
Both lecanemab and donanemab target a brain plaque called amyloid, which builds up over 10 years, according to Rowe.
"You've got to be picked up, diagnosed, and treated early for the drugs to work. It's because this takes amyloid out of the brain, but it doesn't affect what's called tau tangles," he said.
"Tau tangles [abnormal accumulations of a protein called tau in brain cells] really do the damage. If you've already got tau tangles, then removing amyloid doesn't show any benefit."
He said lecanemab can extend people's quality of life and autonomy by around six months, allowing people to keep doing everyday tasks like grocery shopping.
Early diagnosis and cost a barrier
But there are two main issues still to address.
"Issue number one, you've got to get people very early in the disease. So most people won't qualify for this treatment," Rowe said.
"Issue number two is the cost at the moment; it's only available in private, and the drug itself costs around $40,000. But you've got other costs on top of that, which probably build up to about 80,000 in total.
"Without PBS coverage, this is a real impediment for a majority of the population."
Professor Michael Woodwood, the head of dementia research at Austin Health, and an honorary advisor to Dementia Australia, told SBS News the approval is "incredibly important."
He said the introduction of lecanemab could incentivise more people to seek a diagnosis for Alzheimer's sooner.
"There's a lot of fear around getting a diagnosis, and at this stage, the vast majority of cases are not actually diagnosed. I think that the availability of these drugs will change that," he said.
But the drugs won't change health outcomes for people in isolation.
"We need to have a health system that's ready to adapt to the increased number of people wanting a diagnosis," he said.
"It's also important that the people still access all the other support services, the services of Dementia Australia, that they're aware of brain health, which includes exercise, diet, social mental activity, reducing cigarette smoking, et cetera."
A 'new era' for Alzheimer's treatment worldwide
Lecanemab and donanemab approvals are increasing success rates in Alzheimer's treatment, according to global research published in the medical journal The Lancet this week.
Alzheimer's disease accounts for about 70 per cent of all dementia cases worldwide, and scientists say there's more that can be done in caring for patients.
"Blood tests, biological drugs for Alzheimer's disease, and prevention interventions are propelling care into entirely new and exciting territory. However, the old needs of patients will not disappear," Professor Giovanni Frisoni from the University of Geneva said.
He said there needs to be a concerted effort to support current and future patients.
"More general practitioners and dementia specialists will need to master the less glamorous but steady advances made in the past few decades in the care and treatment of behavioural disorders, the use of sophisticated diagnostic imaging and laboratory tools, and psychosocial care."
Meanwhile, Duclos is part of a clinical trial for another drug and receives monthly transfusions as part of the testing.
He is hopeful that drug trials both in Australia and overseas will improve treatment options for Alzheimer's.
"We really need to get the government on board and have money spent in the right places for the right reasons. "
