Health Canada has conditionally authorized the medication lecanemab to decelerate the progression of early-stage Alzheimer’s disease, prompting discussions on its efficacy and accessibility in Canada.
Lecanemab, a man-made antibody administered via intravenous infusion, targets the accumulation of amyloid plaque in the brain, a characteristic feature of Alzheimer’s disease.
While lecanemab is not a cure and cannot reverse the disease or restore lost memories, it is considered the first disease-modifying treatment for Alzheimer’s approved for use in Canada by the Alzheimer Society of Canada. Existing medications focus on symptom management rather than altering the disease’s course.
The effectiveness of the drug and its potential impact on Canada’s healthcare systems are now key considerations for individuals with the disease, their families, healthcare providers, and government authorities.
Under the brand name Leqembi, lecanemab is approved to address mild cognitive impairment and the early stages of Alzheimer’s disease. Patients must exhibit documented amyloid plaque presence in the brain, as stated by the drug manufacturer.
Moreover, patients must undergo testing for gene variants linked to potential adverse effects. The treatment is exclusively accessible to patients with one or no copies of the APOE4 gene variant, as individuals with two APOE4 copies are at higher risk of brain swelling or bleeding.
The availability of genetic testing required for eligibility varies across Canadian provinces and territories.
In terms of effectiveness, Dr. Samir Sinha, a geriatrician and clinician scientist, emphasized the necessity for further research to determine whether the benefits of lecanemab justify its cost. He expressed concerns about the drug’s noticeable impact on maintaining patient independence.
The diagnostic process for Alzheimer’s involves specialized tests like a lumbar puncture or amyloid PET scan to confirm eligibility for lecanemab. The treatment involves biweekly intravenous infusions lasting approximately an hour, with monitoring through PET scans or MRIs for safety and efficacy.
The Canadian Consortium on Neurodegeneration in Aging highlighted potential side effects from clinical trials, including brain swelling or bleeding associated with lecanemab and other antibody treatments.
Regarding cost and coverage, the Alzheimer’s Society advocated for swift market introduction and public funding of lecanemab to ensure affordability for all eligible patients. The drug costs around $26,000 USD annually in other countries. Public coverage may take up to two years post-regulatory approval, while private or extended benefits could offer earlier access.
In 2024, Britain’s National Institute for Health and Care Excellence (NICE) concluded that the benefits of lecanemab were insufficient to justify the costs to the publicly-funded health system, encompassing medication provision and side-effect monitoring.