The race to develop effective treatments for Alzheimer’s disease has drawn together some of the largest pharmaceutical companies in the world, with Japanese firm Eisai, U.S. biotechnology company Biogen, and American drugmaker Eli Lilly & Co. each pursuing distinct approaches that aim to alter the course of a disease long considered intractable. At the center of this contest is Eisai, founded in 1941 and headquartered in Tokyo, whose partnership with Biogen, based in Cambridge, Massachusetts, to develop the antibody lecanemab has placed it at a pivotal intersection of scientific ambition and commercial risk.
A Heavily Financed Competition
The financial stakes in this race are large. Eli Lilly, founded in 1876 and headquartered in Indianapolis, Indiana, reported $34.1 billion in total revenue in 2023.
Biogen reported $10.2 billion in revenue in 2022, while Eisai’s net sales for fiscal year 2022 were approximately 670 billion yen, about $5 billion. A 2023 report by GlobalData projects the global Alzheimer’s drug market will reach $15 billion by 2030, underscoring the commercial incentive for companies investing in this field. Lilly has developed donanemab, an investigational treatment that underwent a Phase 3 trial known as TRAILBLAZER-ALZ 2, which enrolled 1,736 participants.
For Eisai, the collaboration with Biogen offers critical access to the U.S. market and the operational infrastructure Biogen built during its earlier launch of aducanumab, sold as Aduhelm. That drug received accelerated approval from the U.S. Food and Drug Administration in June 2021, despite significant controversy over whether the evidence convincingly demonstrated its effectiveness.
By January 2024, Biogen had withdrawn aducanumab from the market entirely. The withdrawal of aducanumab, after regulatory and clinical disputes that left unanswered questions about the therapeutic value of clearing amyloid from the brain, has opened space for next-generation antibodies like lecanemab and donanemab to be tested more rigorously. The competitive dynamic among these companies has driven substantial investment into Alzheimer’s research, even as the scientific community continues to debate which biological targets–amyloid, tau, inflammation–truly matter for slowing the disease.
A Century of Scientific Struggle
Alzheimer’s disease was first described in 1906 by German psychiatrist Alois Alzheimer, who identified distinctive brain changes: tangled fibers and sticky plaques that disrupt memory and thinking. For decades, research focused on easing symptoms rather than altering the disease’s course. No drug could slow its progress until the late 1990s, when the first cholinesterase inhibitors reached patients.
Those treatments offered only temporary relief. The arrival of monoclonal antibodies targeting amyloid, first in small trials and later in larger studies, marked a turning point in the 2010s, shifting the field toward therapies aimed at the disease process itself.
The approval of aducanumab in 2021, despite mixed clinical evidence, highlighted both the promise and the controversy of this new approach. Its later withdrawal in 2024 underscored how much remains uncertain about amyloid-targeting drugs. Alzheimer’s disease is a progressive brain disorder that erodes memory, reasoning, and daily functioning, eventually leading to complete dependence on caregivers.
It begins with subtle lapses–misplaced keys, forgotten names–then advances through disorientation, mood shifts, and loss of speech and mobility. Over years, the brain shrinks as neurons die.
Most cases arise without a clear cause, though a small share trace to inherited genes. Risk rises with age, head injuries, and conditions such as hypertension or depression. No cure exists. Diagnosis once required autopsy; today, brain scans and spinal fluid tests can reveal signs earlier, yet treatment options remain limited.
Deep Roots in Neurology, Pressing Demographic Need
For more than forty years, Eisai has pursued treatments for brain diseases from its Tokyo headquarters. Grown from a small laboratory into a global pharmaceutical enterprise, the company earned recognition for Aricept, one of the first widely used Alzheimer’s medications. Its long-standing focus on neurology positioned Eisai to lead in amyloid research.
Partnerships with U.S. biotechs became a strategy to accelerate development and gain access to regulatory pathways. The collaboration with Biogen on lecanemab reflects this approach, building on earlier work that produced aducanumab.
What makes Alzheimer’s research matter now is the convergence of scientific opportunity and demographic urgency. Populations in many countries are aging rapidly, increasing the number of people living with dementia. Families face years of care, often at great personal and financial cost.
Governments and insurers strain under rising health costs. Against this backdrop, new therapies that can modestly slow decline offer hope, even if they do not halt the disease.
They also push science forward, forcing clearer answers about which targets–amyloid, tau, inflammation–truly matter. The outcome of these trials and regulatory reviews will shape treatment standards, research priorities, and investment for years to come. For patients, families, and health systems alike, the stakes are not just clinical but deeply human.
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