Leqembi (lecanemab) demonstrates strong long-term patient retention in real-world settings, with nearly 8 out of 10 patients continuing treatment at 18 months and roughly 67% persisting at 24 months. A recent analysis of 10,763 individuals in the United States showed that 90% of patients stayed on the drug during the first 14 months of treatment, indicating that most people who start this Alzheimer’s therapy maintain it as part of their care plan.
These retention rates matter significantly because they suggest the drug is tolerable enough for sustained use and that patients and their families see enough value to continue infusions over extended periods. The findings come from real-world claims data covering patients who received Leqembi between January 2023 and November 2025, providing a clearer picture than clinical trials alone. This article examines what long-term retention means for Alzheimer’s patients, which populations stay on treatment longest, why consistency matters, and what barriers patients face when continuing therapy.
Table of Contents
- What Are the Actual Leqembi Retention Rates in Real-World Practice?
- Who Stays on Leqembi Treatment? Demographics and Medical Factors
- Why Does Patient Retention Matter in Alzheimer’s Drug Therapy?
- How Does Leqembi Treatment Adherence Compare to Other Alzheimer’s Therapies?
- Common Challenges That Cause Some Patients to Stop Leqembi Treatment
- Supporting Patient Adherence to Leqembi Treatment
- What Long-Term Leqembi Data Means for Alzheimer’s Care Going Forward
- Conclusion
What Are the Actual Leqembi Retention Rates in Real-World Practice?
Real-world retention data shows a steady but gradual decline in patient continuation. Among the 10,763 individuals analyzed, 78.4% remained on Leqembi at 18 months, 71.7% at 20 months, and 67.3% at 24 months. The highest retention occurred during the early treatment window, with 90% of patients persisting through the first 14 months.
This pattern suggests that most people who tolerate the initial infusions continue the drug, but some portion choose to discontinue or encounter barriers to continued access as treatment extends beyond the first year. In clinical trials, the commitment rates were even higher—94% of patients who completed the 18-month Core period in the LEQEMBI trial continued into the long-term extension study. The difference between clinical trial retention (94%) and real-world persistence (78% at 18 months) highlights a key reality: patients in structured research settings have more support, monitoring, and motivation to continue than those relying on standard clinical care. The gap between these figures is not unexpected and reflects the practical challenges of maintaining treatment outside a controlled research environment.
Who Stays on Leqembi Treatment? Demographics and Medical Factors
The study population provides insight into who is receiving Leqembi in current practice. The average age was 73.8 years, with women making up 56.5% of the population. Most patients had common age-related conditions: dyslipidemia (abnormal cholesterol levels) was present in 42.2%, and hypertension affected 36.9%.
These statistics matter because they show Leqembi is being used in a realistic population with multiple health concerns, not in young, otherwise-healthy research volunteers. The presence of common comorbidities raises an important consideration: patients managing Leqembi alongside other conditions may face different retention pressures than those in the clinical trial. A person managing high blood pressure, high cholesterol, and early-stage Alzheimer’s disease simultaneously must navigate multiple medications, appointments, and potential drug interactions. However, the retention data suggests that despite these complexities, most people do continue Leqembi, which implies that patients and their doctors view it as worth incorporating into an already-complex treatment regimen.
Why Does Patient Retention Matter in Alzheimer’s Drug Therapy?
Leqembi’s mechanism of action requires consistent administration to work effectively. The drug slowed cognitive decline by 27% compared to placebo during the 18-month Core trial period—not a cure, but a measurable delay in the decline trajectory. This benefit only materializes if patients actually receive the infusions on schedule. Missing doses or discontinuing treatment undermines the drug’s ability to slow progression, so retention rates directly correlate with whether patients in a community setting can achieve the benefits shown in trials.
Consistency also matters for disease monitoring. Patients on Leqembi require periodic amyloid PET scans or other biomarker testing to identify amyloid-related imaging abnormalities (ARIA), which are potentially serious side effects. Regular infusions create touchpoints for monitoring and clinical assessment. When patients drop out of treatment, they often exit the monitoring cycle as well, leaving caregivers and family members without the structured updates on disease state that the treatment regimen provides.
How Does Leqembi Treatment Adherence Compare to Other Alzheimer’s Therapies?
Leqembi’s 78% retention rate at 18 months compares favorably to some earlier Alzheimer’s drugs but reveals challenges when compared to easier-to-manage oral medications. Traditional oral Alzheimer’s medications like donepezil (Aricept) often have higher long-term persistence, partly because taking a daily pill is simpler than coordinating IV infusions every two or four weeks. The infusion requirement—which means scheduling clinic appointments, travel, and time investment—creates friction that oral drugs do not.
This tradeoff is a real disadvantage of Leqembi despite its superior disease-slowing benefit. However, Leqembi’s retention rates suggest that the benefit-to-burden ratio works for most patients. The need for infusions, potential side effects, and time commitment do not cause retention to collapse, indicating that patients who start therapy perceive enough benefit or have enough family support to continue. This differs sharply from some older Alzheimer’s therapies that patients abandoned at higher rates due to side effects or perceived ineffectiveness.
Common Challenges That Cause Some Patients to Stop Leqembi Treatment
Between 78% retention at 18 months and 67% at 24 months, roughly 11% of patients discontinue or miss treatment windows. Several factors likely contribute to attrition. The logistical burden of biweekly or monthly infusions is significant for patients and caregivers, especially in rural areas or among those with limited access to specialized clinics. Transportation challenges, competing medical appointments, and the simple difficulty of maintaining a treatment schedule for a progressive cognitive disease can push people toward discontinuation.
Amyloid-related imaging abnormalities (ARIA) present another barrier. Some patients develop swelling in the brain (ARIA-E) or microhemorrhages (ARIA-H) during treatment, requiring dose reductions, more frequent monitoring, or discontinuation. While ARIA is manageable with close observation, the news of brain abnormalities—even if asymptomatic—can cause patients and families to lose confidence in the drug and opt out. Additionally, the time lag between starting treatment and seeing measurable cognitive benefit (which may take months) tests patients’ commitment, especially if they develop side effects early.
Supporting Patient Adherence to Leqembi Treatment
Retention is not automatic and depends significantly on the strength of the clinical relationship and caregiver involvement. Patients who remain on Leqembi long-term typically have clear communication with their neurologist or memory clinic, understand the expected benefits and risks, and have family support for logistics. Clinics that invest in patient education—explaining the 27% slowing of decline, the importance of scheduled infusions, and the monitoring process—see better persistence than those offering minimal counseling.
An example of successful adherence support is the structured memory clinic model, where a multidisciplinary team (neurologist, nurse coordinator, social worker) manages all aspects of Leqembi care. These clinics schedule infusions in a coordinated setting, handle insurance authorization and appeals, track imaging results proactively, and address patient concerns before they become barriers. Caregiver involvement is equally critical; families who understand the treatment plan and share responsibility for adherence show higher retention rates than isolated patients trying to manage therapy alone.
What Long-Term Leqembi Data Means for Alzheimer’s Care Going Forward
The real-world retention data reinforces that Leqembi is becoming established as a standard early-treatment option in U.S. Alzheimer’s care. High early retention rates (90% through 14 months) suggest that patients and clinicians view the drug as acceptable once they begin, even with the infusion burden.
The gradual decline from 78% to 67% over 6 more months reflects a realistic erosion of motivation and logistical capacity rather than sudden mass rejection of the therapy. As newer amyloid-targeting monoclonal antibodies enter the market, including donanemab and others in development, the field will learn whether any offer retention advantages through improved tolerability, easier infusion schedules, or stronger cognitive benefits. The Leqembi retention benchmarks establish what current memory care can achieve and provide a foundation for evaluating whether next-generation therapies improve outcomes. For patients and families currently considering Leqembi, the data suggests that if they commit to starting the drug, most will likely continue it long-term with proper clinical support.
Conclusion
Leqembi demonstrates solid long-term patient retention, with nearly 8 in 10 patients continuing at 18 months and two-thirds persisting at 24 months. This retention validates that the drug’s disease-slowing benefit (27% slowing of decline) justifies the inconvenience and potential side effects for most patients who begin treatment. The real-world data also shows that while early persistence is high, some patients discontinue due to logistical challenges, treatment side effects, or loss of motivation as time passes.
For individuals and families considering Leqembi, these retention rates offer reassurance that long-term adherence is feasible. The key is ensuring strong clinical support, clear communication about benefits and risks, and involvement of family caregivers in managing the treatment schedule. If you or a loved one has been diagnosed with early-stage Alzheimer’s disease, discussing Leqembi with your neurologist and exploring what long-term treatment persistence looks like in your clinical setting is an important part of treatment planning.
