Patient attitude towards lecanemab: results from a survey within the European Alzheimer’s disease consortium (EADC), the German memory clinic network (DNG) and Austrian memory centers

INTRODUCTION Lecanemab approval was long pending in the EU but has now been granted. European patient attitudes towards anti-amyloid therapies are insufficiently assessed and reported.

We conducted an anonymous, multicenter survey across European memory clinics targeting patients with early symptomatic AD. A standardized questionnaire with four yes/no questions assessed attitudes toward lecanemab treatment and approval, including in the context of APOE4 homozygosity.

Among 281 participants, endorsement rates were high for both individual treatment (82%) and general EU approval (92%). While still high, support was lower for treatment and approval in the context of APOE4 homozygosity (61% and 77%). Support for approval for APOE4 homozygotes declined after regulatory recommendations excluded this group. Results were consistent across European regions.

Strong support for access to lecanemab reflects the significant patient need for disease-modifying therapies and underscores the importance of considering patient perspectives in regulatory decision-making. Competing Interest Statement Jonathan Voeglein received speaker fees from Novo Nordisk, Eisai and Lilly, and consulting fees from Eisai. He received coverage for conference and travel expenses from Biogen, Lilly, Eisai, Novo Nordisk, the Alzheimer's Association, the Austrian Alzheimer's Society and the German Society of Nuclear Medicine. All relationships outside the submitted work. Johannes Levin reports speaker fees from Bayer Vital, Biogen, EISAI, TEVA, Zambon, Esteve, Merck and Roche, consulting fees from Axon Neuroscience, EISAI and Biogen, author fees from Thieme medical publishers and W. Kohlhammer GmbH medical publishers and is inventor in a patent "Oral Phenylbutyrate for Treatment of Human 4-Repeat Tauopathies" (PCT/EP2024/053388) filed by LMU Munich. In addition, he reports compensation for serving as chief medical officer for MODAG GmbH, is beneficiary of the phantom share program of MODAG GmbH and is inventor in a patent "Pharmaceutical Composition and Methods of Use" (EP 22 159 408.8) filed by MODAG GmbH, all activities outside the submitted work. Elisabeth Stoegmann's institution received financial support by research grants for research in AD: Eisai, EU Horizon 2020, Austrian Research Promotion Agency. Her institution received financial support for participation in clinical trials from Biogen, Novo Nordisk and Roche Diagnostics. She received honoraria (consultations, lectures, speakers bureaus, educational events, advisory boards) from pharmaceutical companies: Biogen, Roche, Novo Nordisk, Eisai, Novartis, Sanofi and Lilly. She held leadership in scientific societies: Austrian Alzheimer Association. All relationships outside the submitted work. Christian Haass collaborates with Denali Therapeutics and is a member of the advisory boards of AviadoBio, Cure Ventures, and Curie.Bio. Guenter Hoeglinger serves as a consultant for Abbvie, Alzprotect, Amylyx, Aprinoia, Asceneuron, Bayer, Bial, Biogen, Biohaven, Epidarex, Ferrer, Kyowa Kirin, Lundbeck, Novartis, Retrotope, Roche, Sanofi, Servier, Takeda, Teva, UCB; received honoraria for scientific presentations from Abbvie, Bayer, Bial, Biogen, Bristol Myers Squibb, Kyowa Kirin, Pfizer, Roche, Teva, UCB, Zambon. Lutz Froelich received honoraria for consulting and for lectures from Biogen, Eisai, GE Healthcare, Grifols, Hummingbird, Janssen-Cilag, Eli Lilly, MerckSharpe&Dohme, Neurimmune, Noselab, Novo Nordisk, Hoffmann-LaRoche, TauRX, Schwabe. All relationships outside the submitted work. Frank Jessen received honoraria for advisory boards and presentations from Abbvie, AC immune, Biogen, Eli Lilly, Eisai, GE Healthcare, Grifols, Janssen-Cliag and Roche. Funding Statement This work was funded by the Deutsche Forschungsgemeinschaft under Germany's Excellence Strategy within the framework of the Munich Cluster for Systems Neurology (EXC 2145 SyNergy - ID 390857198). Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The survey was conducted anonymously and collected no personal or demographic data. The ethics committee of LMU Munich confirmed that no formal consultation was required for conducting this anonymous survey (reference number: 24-0894-KB). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data produced in the present study are available upon reasonable request to the authors.