Health Canada has granted Lecanemab authorization under the name it is marketed, Leqembi. This game-changing treatment addresses the underlying cause by modifying the progression of Alzheimer’s disease. It is the first new Alzheimer’s therapy to arrive in Canada in almost two decades, according to this approval. It stirs up hopefulness and doubt within the medical field and the patient population.
By specifically targeting the beta-amyloid plaques that accumulate in the brains of people with Alzheimer’s, lecanemab works at the root of the disease’s underlying pathology. Yet, its safe administration hinges on genetic testing to identify if people are at a higher risk of severe side effects. Patients need to get scans to prove there’s the presence of these plaques before they’re even allowed to start treatment. Healthcare providers and patients alike are expected to solve the logistical challenges posed by the drug’s administration. It’s a complicated medicine that requires intravenous infusions every two weeks.
Even with the excitement around Lecanemab’s debut, its effectiveness is still under discussion. Clinical trial data indicates that patients receiving the drug experienced a modest delay in disease progression, approximately five months compared to those in the control group. This raises questions about the drug’s overall impact on quality of life for individuals diagnosed with mild cognitive impairment or early Alzheimer’s disease.
Lecanemab has its own hefty cost, at $26,500 per year in the U.S. At this point we don’t yet know what the cost will be for Canadian patients. The high price will reduce access to a treatment that already reaches only a small percentage of eligible patients. In the U.S., the data tells a shocking truth. In fact, only 8% to 15% of people who expressed interest in Lecanemab would meet eligibility criteria for treatment.
John Dalrymple-Fraser, a patient advocate who spoke in favor of Lecanemab, underscored just how important Lecanemab would be. He stated, “If tomorrow, I couldn’t remember my family [but] I’m told that taking this drug [means] I could for at least five more months? Give me that drug.” He wishes he had more hours to spend with his family and friends. This wish is a powerful reminder of the emotional stakes involved in treatment choices.
As we welcome this news, experts urge us not to pin our hopes on Lecanemab’s arrival. Manuel Montero-Odasso, a geriatrician, remarked, “We need to be very clear with the public health system that the clinical effect is very, very modest.” This statement captures a sentiment echoed much more widely that the expectations for the drug are higher than the expected benefits the drug will deliver.
Andrew Frank, a neurologist, echoed similar sentiments, stating, “It’s not a cure. It is an incremental benefit that we hope would lead to more discoveries in the future.” This view calls for comprehensive, long-term focus on research and development to bring effective Alzheimer’s treatments to market. It’s real because it understands that Lecanemab, while certainly a progress of sorts, will not be the final cure.
Moreover, there are concerns that Lecanemab’s introduction could divert crucial resources away from other supports or interventions that may more significantly improve the lives of Alzheimer’s patients and their families. This treatment will be hard for our current healthcare system to handle. It requires support services that are integral to providing the holistic patient care that the model fosters.
Currently, only two tests exist for detecting beta-amyloid plaques: a lumbar puncture or spinal tap and an amyloid PET scan. Yet, in Canada, neither of these tests are regularly used during diagnosis for Alzheimer’s. This underappreciated barrier may preclude countless patients from accessing Lecanemab.
