Eisai’s launch of Leqembi in India brings one of the world’s first disease-modifying Alzheimer’s treatments to a country where an estimated 8.8 million people aged 60 and above were living with dementia based on 2016 population projections.
The drug’s maximum retail price of ₹21,682 per vial puts a number on the treatment, but price is only one part of the challenge.
Leqembi is intended for people in the early stages of Alzheimer’s disease, requires confirmation of amyloid pathology and comes with monitoring requirements. India’s ability to identify and treat eligible patients will be as important as the drug’s availability.
Leqembi Changes Alzheimer’s Treatment
Leqembi, or lecanemab, belongs to a new class of Alzheimer’s medicines designed to target an underlying biological feature of the disease rather than only manage its symptoms.
The monoclonal antibody targets aggregated forms of amyloid beta in the brain and is approved for patients with mild cognitive impairment or mild dementia due to Alzheimer’s disease, with confirmed amyloid pathology.
That distinction is central to understanding the size of the potential Indian market. The number of people living with dementia cannot simply be treated as the number of potential Leqembi users. The drug is intended for a specific stage of Alzheimer’s, and patients must meet the relevant diagnostic criteria.
The US FDA’s traditional approval was based on the pivotal Phase III CLARITY AD trial, which enrolled 1,795 participants with early Alzheimer’s disease. Patients received Leqembi at 10 mg/kg every two weeks.
Over the 18-month study period, the treatment produced a statistically significant reduction in decline on the trial’s primary clinical measure compared with placebo.
The significance of Leqembi, therefore, is not that it cures Alzheimer’s. Rather, its clinical proposition is to slow the progression of cognitive and functional decline in appropriately selected patients at an early stage of the disease.
India’s Dementia Burden Is Growing
India’s ageing population provides the broader demographic context for the launch. A nationally representative study using data from the Longitudinal Ageing Study in India estimated dementia prevalence among people aged 60 and above at 7.4%.
Using the study’s prevalence estimate and population projections for 2016, researchers estimated that approximately 8.8 million Indians aged 60 and above were living with dementia. The study projected that this number could reach 16.9 million by 2036, assuming the prevalence rate remained unchanged.
The figures highlight the scale of the long-term healthcare challenge, but they should not be interpreted as the current number of potential Leqembi patients. Dementia includes multiple conditions, while Leqembi is indicated for a defined group of people with early Alzheimer’s disease and confirmed amyloid pathology.
The gap between the overall dementia burden and the addressable patient population is likely to be one of the defining features of India’s Alzheimer’s drug market.
Price Is Only One Hurdle
At ₹21,682 per vial, Leqembi’s listed price offers a starting point for assessing affordability. But the vial price alone does not represent the complete cost of treatment. Leqembi is administered intravenously and uses weight-based dosing, while patients receiving the therapy require appropriate clinical assessment and monitoring.
The US prescribing information also carries a boxed warning for amyloid-related imaging abnormalities, or ARIA, which can include brain swelling and bleeding. The risk profile makes patient selection and monitoring an important part of treatment delivery.
This means the economics of Leqembi in India will extend beyond the medicine itself. The broader treatment pathway involves identifying patients at an early stage, confirming amyloid pathology and ensuring that eligible patients can access appropriate medical supervision.
Business Standard’s report also highlights the challenges around diagnosis and treatment infrastructure in India. These factors could influence how quickly the drug moves from regulatory approval to wider clinical adoption.
Local Evidence Will Matter
The India launch also comes with an evidence gap. Business Standard reported that Indian patients were not included in the pivotal clinical trial and that Eisai plans to conduct a Phase IV post-marketing study in India.
Local data could become important as doctors gain experience with the treatment and policymakers assess its role in India’s healthcare system. The study may also provide additional information about the drug’s use among Indian patients in real-world clinical settings.
For the company, the challenge is consequently not just regulatory approval. The commercial opportunity will depend on whether the healthcare ecosystem can identify patients early enough for treatment and support the diagnostic and monitoring requirements associated with the therapy.
Competition Could Expand Options
Eisai is not entering the Indian Alzheimer’s market without competition. Business Standard reported that Eli Lilly had launched its own Alzheimer’s disease-modifying treatment, Lormalzi, in India about a month earlier.
The arrival of multiple therapies could give neurologists and patients more treatment options as clinical experience develops. Over time, competition may also influence how companies approach pricing, patient support and access. However, the effect on affordability and market penetration remains to be seen.
Leqembi’s India launch is therefore an important milestone, but its broader impact will be measured beyond the number of vials sold. India’s dementia burden is projected to rise as the population ages, while disease-modifying treatments require early diagnosis and specialised care.
The real test for the Indian market will be whether the introduction of these therapies can be matched by a healthcare system capable of finding the right patients, confirming their eligibility and providing the monitoring needed to treat them safely. The launch opens the door to a new phase in Alzheimer’s care. Whether that translates into meaningful access will depend on what happens beyond the drug itself.
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