Health Canada recently conditionally approved Lecanemab, sold under the name Leqembi. This new medicine is approved for treatment of mild cognitive impairment and early stages of Alzheimer’s disease. It is the first major advance in the treatment of this condition, which impacts millions of people around the world. Experts have warned against over-hyping Lecanemab, saying while it does slow cognitive decline, it isn’t a cure. As a result, they are calling for greater consideration before fully translating this treatment into clinical practice.
Lecanemab is a laboratory-developed antibody given by IV infusion every two weeks, with each infusion taking about an hour. Individuals need to have documented amyloid plaque in their brains to be eligible for this treatment. Throughout our brain, this plaque is one of the main hallmarks of Alzheimer’s disease. Only those with one or no copies of the APOE4 gene variant are eligible to take the drug. Those who carry two copies face a much greater risk for serious adverse effects such as swelling or bleeding in the brain.
Understanding Treatment Parameters
Though Lecanemab brings hope, it is important to be clear-eyed about its limitations. The drug doesn’t reverse Alzheimer’s disease or restore lost memories. According to Dr. Samir Sinha, “Right now, it takes about 18 months before you might notice some sort of significant difference.” This timeline highlights the importance of understanding that treatment requires time and a commitment to long-term healing.
The cost of Lecanemab is yet another important factor. In nations that offer it, the yearly cost approaches $26,000 US. This out-of-pocket cost flies in the face of considerations about accessibility in any publicly funded health care system. Just recently Britain’s National Institute for Health and Care Excellence decided that the benefits of Lecanemab do not outweigh their excessive cost.
This disturbing gap was highlighted by Dr. Howard Chertkow, chair of the Commons health committee. He cites treatment research indicating that women could get a fraction of the benefit that men do from treatments. He goes on to stress the importance of more focused research to figure out who might benefit the most from Lecanemab.
Implications for Healthcare Systems
The approval of Lecanemab requires deep upfront planning within healthcare systems to deliver treatment fairly. The UK’s Alzheimer’s Society has warned that meeting these demands will need massive financial investment. We must reinvest to strengthen human resources, infrastructure, training and foster new career pipelines to support effective and equitable treatment delivery at scale.
This sentiment is indicative of the general, daunting challenges tied to bringing new medications into established health systems. Experts like Dr. Sharon Cohen see Lecanemab as a step forward but emphasize the need for ongoing treatments: “You get a first, disease-slowing medication and then you add to it.” Both perspectives underscore that Lecanemab should be seen as an important first step in treatment. We need to start thinking about it within the context of other care alternatives.
The Future of Alzheimer’s Treatment
The conditional approval from Health Canada, is a monumental step forward in the treatment and management of early-stage Alzheimer. The majority of healthcare providers are now entering this new and expert landscape for the first time. They need to consider what Lecanemab is appropriate for their patients. Curiously, one unnamed expert went on the record with his enthusiasm for the FDA’s blessing of the other drug. Dang, they said, that’s probably not what’s best for the majority of their patients.
