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SHANGHAI — For the past year or so, Yan has found herself preoccupied with a minor detail from a 2019 trip across Northwest China she took with her then 70-year-old mother. The pair had just ordered a rideshare, but no matter how many times Yan told her mom the car was on its way, the older woman kept asking where it was. “I thought she was just nervous,” Yan tells Sixth Tone.
Now the 50-year-old small business owner from Changzhou, about an hour outside Shanghai, wonders if it was a warning sign. Last year, Yan’s father noticed that her mother, surnamed Zhang, seemed to be having memory problems. After talking it over, Yan and her father decided to take her for a check-up.
The diagnosis was devastating: Zhang was showing early symptoms of Alzheimer’s, a progressive neurological disease and the most common type of dementia.
“Alzheimer’s is something you see on TV,” says Yan, who asked to be identified only by her surname for privacy reasons. “I never thought it would affect someone so close to me.”
There were nearly 10 million people living with Alzheimer’s in China in 2022, according to official statistics. Roughly 5% of people over the age of 65 have been diagnosed with the disease, according to the China Association for Alzheimer’s Disease (CAAD). That rises to 30% among people aged 80 and above.
On average, patients over 65 years old have a post-diagnosis life expectancy of between four and eight years, though some can live as long as 20 years. There is no cure and very few proven treatment options.
That is starting to change, however. One of the most promising new drugs to reach the market in recent years is Lecanemab, which was jointly developed by the Japanese pharmaceutical giant Eisai and the U.S.-based Biogen. Lecanemab, also known by its commercial name, Leqembi, works by targeting amyloid plaques that build up in the brains of Alzheimer’s patients, helping to slow the cognitive and functional decline caused by the disease.
After being approved by the U.S. Food and Drug Administration in January 2023, Lecanemab was greenlit for use last October by the Boao Lecheng International Medical Tourism Pilot Zone, on China’s southern island province of Hainan.
This January, the drug received full approval from China’s National Medical Products Administration, making it the only amyloid beta-directed antibody approved by both the U.S. and China to treat Alzheimer’s. China is the third country, after America and Japan, to officially approve Lecanemab. Patients and their loved ones, like Yan, hailed the news as a potential life-extending breakthrough. But doctors and experts have struck a more cautious tone, seeking to balance their enthusiasm for the drug with the reality that its effects are limited and largely dependent on early detection — a traditional weakness of China’s elder care system.
“The launch of this new drug signifies a transition from the treatment of symptoms to an era of disease-modifying treatment, which is a groundbreaking milestone,” says Wang Gang, Zhang’s doctor and the director of the Department of Neurology at the Shanghai Jiao Tong University School of Medicine’s Renji Hospital.
“But if you give it to the wrong people, it’s not just wasteful — the side effects can be severe, including brain microbleeds and edema in the brain tissue.”
Early adopters
This June, six months after Lecanemab received full regulatory approval, the drug reached pharmacy shelves. On June 26, a 58-year-old Alzheimer’s patient at Capital Medical University in Beijing officially became the first person in China outside Boao to receive a Lecanemab prescription.
The very next day, Yan took her mother to a clinic in Shanghai to start treatment.
After confirming her mother’s memory issues last year, Yan struggled to find useful treatment information on the internet. But when she heard that Chinese regulators might approve Lecanemab in late 2023, she was suddenly filled with hope. “I was thrilled,” she recalls.
An acquaintance helped connect her to a doctor in Shanghai. Soon, she was taking her mother to regular appointments in the city — part of a lengthy pre-screening process to ensure patients can take the drug safely.
Now, Yan and her mother make the hourlong high-speed train journey to Shanghai every other Thursday, then catch a taxi to the Yuyuan Community Healthcare Center in the city’s downtown. There, her mother undergoes a roughly two-hour injection, then stays overnight for observation.
According to Wang, Zhang’s doctor, Lecanemab treatment requires constant evaluation. “For the first three to four months, we’ll take a look at the results, then conduct neurological and blood assessments as well as an MRI, to ensure the safety and effectiveness of the drug,” he says.
In addition to treating patients, Wang runs the Yuyuan Community Healthcare Center’s Memory Clinic, part of a broader effort to bring hospital resources into the smaller community clinics that dot China’s cities.
More than 60% of the Yuyuan Center’s patients are middle-aged or elderly, according to Zhang Yang, the center’s dean of medicine and the director of a nearby eldercare hospital.
The Memory Clinic came about as a collaboration between the center and Wang’s employer, Renji. At the time it opened in 2023, it was the city’s only community-level clinic for cognitive disorders.
“We hope that by collaborating with top-tier hospitals, we can help some patients access medications like Lecanemab closer to home,” Zhang says.
Early detection
Treatments like Lecanemab are most effective when the disease is caught early, before it has the chance to progress. But only 13% of Alzheimer’s patients actively seek medical help, according to a 2022 CAAD report, with reasons ranging from poor awareness and an unwillingness to admit memory problems to an inability to access medical resources.
For those willing to seek help, finding qualified doctors can be a challenge. Even top Chinese hospitals do not always have enough dedicated staff to treat cognitive impairment, something that Wang believes will slow the uptake of Lecanemab in the country.
“Unlike neurology departments, which are relatively common in hospitals, resources for cognitive impairment vary greatly between regions and even within them, and technical expertise is not evenly distributed,” Wang says.
Wang believes that advancing the treatment of Alzheimer’s will require a coordinated effort reaching into communities, and advocates making cognitive tests a part of basic check-ups for elderly patients.
According to Guo Qihao, director of Geriatric Medicine at Shanghai’s Sixth People’s Hospital, reaching out to patients is crucial because many people suffering from memory loss are reluctant to accept the possibility they have dementia.
“Many early-stage patients will deny having any problems and will try their best to cover it up,” Guo says. For example, they’ll start making notes in their notebooks to remind themselves of things, which keeps family members from picking up on the problem.”
Yan’s mother still rejects her diagnosis. “Especially when it comes to the term ‘dementia,’ she is very reluctant to admit it,” Yan says. “She’ll say, ‘I’m forgetting things because of my stroke, not because of Alzheimer’s. I don’t have dementia.’”
For now, Yan has decided to play along. She has told her mother that the treatments in Shanghai are for an unspecified “memory disorder,” and that the medicine might help her recover some of her memory.
Managing expectations
A material improvement in memory might be beyond Lecanemab’s abilities, however. Although the drug has been shown to slow the advancement of Alzheimer’s in some cases, it is far from a cure, and the effects vary depending on the individual.
“There is no cure for Alzheimer’s yet, and the effects of treatment are not ideal,” says Guo. “The new drugs can only delay its progress, like tapping on the brakes when going downhill.”
Meanwhile, the financial cost of treatment is high. A 200-milligram bottle of Lecanemab, which is not yet covered by China’s health insurance scheme, will run patients 2,508 yuan ($344). A patient weighing 60 kilograms needs three bottles of the drug per biweekly treatment, meaning an 18-month course of the drug could run them almost 300,000 yuan.
While it’s too early to say how the public will react to those costs, the high price tags and limited results of earlier Alzheimer’s treatments have sometimes left family members frustrated. Qian, one such individual, whose mother was diagnosed with Alzheimer’s roughly eight years ago, questions the cost-to-benefit ratio of medicines. (Citing privacy reasons, Qian asked to be identified only by his surname.)
“Many family members (of patients) I know feel that the cost-performance ratio is somewhat low,” he tells Sixth Tone. “The delaying effect may not be as good as some non-drug interventions.”
The issue of side effects, combined with the need to select patients whose disease has not progressed very far, has further complicated Lecanemab’s rollout in China. Wang and Guo both told Sixth Tone that the drug is only suitable for early-stage patients with dementia caused by Alzheimer’s, which means those showing signs of amyloid buildup in the brain.
Patients with metal implants and who cannot undergo MRIs cannot take the drug, as MRI scanning plays an important role in detecting common side effects like brain hemorrhages or swelling. Other underlying conditions, such as diabetes, may also affect the use of the medication.
According to Guo, around 70% of the patients who visit his clinic for Alzheimer’s treatment don’t qualify for Lecanemab, mostly because their cases are too advanced.
Despite the caveats surrounding the drug, Yan is grateful that her mother was able to qualify, and she’s hopeful it can help slow the disease’s progress.
“Even a delay is good, as it gives us more time for new medications to reach the market,” she says.
Contributions: Zhu Yingcui.
(Header image: Visuals from Westend61 and drawlab19/VCG, reedited by Sixth Tone)
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