After the July 13, 2026 FDA decision, people with mild cognitive impairment from early Alzheimer's have two ways to start Leqembi. They can use weekly shots at home or IV infusions at a clinic.
Mild cognitive impairment means memory or thinking changes you notice, but you still manage daily tasks. Leqembi is a prescription antibody drug that targets amyloid-beta in the brain. Starting at home without prior IV care became possible only in 2026.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Official resources:
- Read the official notice from Eisai — Use this primary source to verify the official announcement.
- Read the official notice from Bioarctic — Use this primary source to verify the official announcement.
Table of Contents
- Who qualifies for either option?
- How do at-home shots and IV infusions compare?
- Why do clinic visits continue with home dosing?
- What should you ask about genes and cost?
Who qualifies for either option?
Both IV and at-home Leqembi are only for early Alzheimer's disease. That means mild cognitive impairment or mild dementia with confirmed amyloid-beta pathology. The Alzheimer's Association notes that doctors typically confirm amyloid by PET scan or spinal fluid testing before treatment.
A specialist visit should confirm the exact cause of memory changes. Other brain conditions, medicines, sleep problems, and mood disorders can mimic early Alzheimer's. Amyloid confirmation protects patients from taking a drug that does not fit their disease.
- Do my test results show mild cognitive impairment or mild dementia from Alzheimer's?
- Has amyloid been confirmed by PET or spinal fluid testing?
- Could another condition explain my symptoms?
How do at-home shots and IV infusions compare?
At-home initiation uses 500 mg once weekly as two back-to-back 250 mg autoinjector shots, according to Eisai in its July 2026 announcement. Before 2026, the at-home injector was approved only as weekly maintenance after 18 months of IV care. The new approval allows eligible patients to start treatment at home.
Traditional IV Leqembi remains 10 mg/kg over about one hour every two weeks for 18 months, as described by The Medical Letter in its April 2025 drug summary. After that period, patients may continue IV every four weeks or switch to weekly 360 mg shots for maintenance. Home injections take about 15 seconds each and do not need an infusion center.
- Start at home: two shots, once weekly, given by patient or care partner
- Start by IV: clinic infusion, about one hour, every two weeks
- Later: stay on spaced IV doses or change to weekly maintenance shots
Why do clinic visits continue with home dosing?
Home dosing does not remove brain safety checks. Eisai reports that FDA labeling retains a boxed warning for amyloid-related imaging abnormalities, called ARIA. Patients still need a baseline MRI, follow-up MRIs, and ApoE ε4 gene testing before starting.
ARIA means swelling or bleeding spots seen on MRI during amyloid treatment. Follow-up scans can catch changes before symptoms appear. Ask how the clinic schedules scans, reads results quickly, and handles missed appointments.
- What is my MRI schedule before and during treatment?
- What symptoms should prompt an urgent call or emergency visit?
- Who reviews scans, and how fast will I hear results?
What should you ask about genes and cost?
ApoE ε4 homozygotes, about 15% of Alzheimer's patients, face higher rates of symptomatic and serious ARIA than other groups. Eisai reported this risk pattern in its July 2026 notice. Genotype testing helps the specialist explain personal risk and watch more closely when needed.
Cost is a separate planning question. Managed Healthcare Executive reported in its August 2026 cost summary that each autoinjector lists at $385, or $770 weekly for initiation. The same report notes a Medicare Part D yearly cap near $2,100, plus maker support up to $10,000 yearly and free drug for some uninsured patients.
- Should I have ApoE ε4 testing, and how will results change my plan?
- What will my plan pay, and what help can lower the copay?
- Bring a full drug list, prior MRI reports, gene-test consent questions, and insurance details to the visit.
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