BURST
A recommendation by Canada’s Drug Agency could make it more difficult for Canadians to access a drug shown to slow Alzheimer’s disease in some people, says an Ottawa cognitive neurologist and researcher.
Dr. Andrew Frank , who is with the Bruyère Health Memory Clinic and Bruyère Health Research Institute, says he is disappointed that Canada’s Drug Agency recommended public drug plans should not cover the cost of lecanamab — a drug to slow early-stage Alzheimer’s disease. The drug agency issued the ruling last week.
“This means there will be less access for patients,” Frank said.
The drug, which was approved by Health Canada in 2025 , has been hailed by some as a historic step in the treatment of a disease projected to affect one million Canadians by 2030.
However, a leading geriatrician says the drug is a positive advance that bodes of more advances to come — but it is not a game-changer for Alzheimer’s patients and their families.
Lecanamab is one of a group of drugs known as anti-amyloid therapies. It has been shown to slow the progress of Alzheimer’s disease in some patients with cognitive impairment by targeting amyloid protein buildup in the brain, believed to be part of the brain-damaging effects of Alzheimer’s disease.
The drug isn’t right for everyone and comes with rare, but serious risks. It is also costly: up to about $32,000 a year for treatments that consist of twice-monthly infusions and require MRIs.
But it is the first new treatment for Alzheimer’s disease in Canada in 20 years and the first that aims to target an underlying cause of the disease rather than symptoms.
“It is not a cure, but it does slow the condition, which may translate into more time doing things that we enjoy and more time with loved ones,” Frank said.
The drug was shown in clinical trials to reduce the progression of Alzheimer’s disease by 27 per cent. That means patients who received the treatment as part of the double blind study experienced a slowing of their disease progression. They did continue to get worse, but at a slower rate than most of those not on the treatment. The treatment comes with a small, but serious, risk of brain bleeds and brain swelling.
Frank says he is hopeful that the drug will be covered through private health plans. A small number of Canadians are paying for the drug themselves.
The Canada’s Drug Agency recommendation did not come as a surprise to Dr. Samir Sinha, who is a geriatrician at Sinai Health System and the University Health Network in Toronto. He notes that it is in line with most jurisdictions around the world, including the NHS in the United Kingdom and the European Drug Agency.
Sinha says the drug is promising and raises hopes that future drugs will be more effective, but it is far from a game-changer. He compares it to early versions of chemotherapy.
He says the medication is proving to be effective at clearing amyloid in patients’ brains. “The is good, but it is not also having that level of effect on improving memory.”
He says the question for Canada’s Drug Agency is whether a drug makes a clinically meaningful difference, given the cost and potential risk factors.
Sinha also notes that, while the drug slowed disease progression by a few months in men, it has proven to be much less effective in women. Women are more likely to develop dementia.
But he says there are other things people can do to make a meaningful difference in the progression of dementia, including social stimulation and physical activity. The money spent on medication could also be used to pay for social supports, he says.
Sinha also says the Canadian health system is not set up to identify early cognitive impairment that could lead to Alzheimer’s disease, which limits the number of people who would be identified in time to take advantage of a treatment aimed at an early stage of the disease. Upwards of 70 per cent of Canadians living with dementia are undiagnosed — one of the highest rates in the world.
Meanwhile, Frank, who is president of the Consortium of Canadian Centres for Clinical Cognitive Research, will be guiding the deployment of new treatments and co-ordinating a national treatment registry to track the safety and effectiveness of such treatments across Canada.
He says he believes it is important for the drug to leave the clinical trial world and “enter the real world” where its value as treatment for patients in the earliest stages of Alzheimer’s can be better understood.
Bruyère is working with partners to offer the drug, safely, in the region, including on a compassionate basis for some patients.
Lecanamab is one of two drugs showing some progress in targeting amyloid protein. There are also other drugs in the pipeline, creating a growing feeling of hope in the Alzheimer’s community.
The drug agency recommendation remains open for feedback until March 5.
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