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For the first time in nearly two decades, Health Canada has approved a groundbreaking medication for Alzheimer's disease that targets the underlying cause rather than just managing symptoms. Lecanemab, approved in about 50 countries worldwide, represents a significant shift in how this devastating condition might be treated going forward.
This new Alzheimer's disease treatment has shown promising results, potentially delaying disease progression by 10 to 13 months. However, it comes with important considerations including cost—approximately $26,000 US per year in other countries—and certain risks for some patients. For the estimated 771,000 Canadians currently living with dementia, this development offers both hope and questions about accessibility.
Unlike previous medications that only addressed symptoms, lecanemab specifically targets the buildup of amyloid plaque in the brain, which many researchers believe contributes to the cognitive decline associated with different types of Alzheimer's disease. Experts are calling this approval historic, especially considering the projection that Alzheimer's disease will affect one million Canadians by 2030.
Approved on October 25, 2025 by Health Canada, lecanemab marks a historic milestone as the first disease-modifying Alzheimer's treatment authorized in Canada. Clinical trials demonstrated remarkable results—the drug slowed clinical decline by 27% after 18 months compared to placebo. Furthermore, in the specifically indicated population of Alzheimer’s sufferers, the reduction in mental decline increased to 33%.
The medication is administered through intravenous infusion every two weeks. It's strictly indicated for adults with mild cognitive impairment or mild dementia due to Alzheimer's disease who have confirmed amyloid pathology. Additionally, patients must be either apolipoprotein E ε4 non-carriers or heterozygotes.
What makes lecanemab truly groundbreaking is its ability to address an underlying cause of Alzheimer's disease instead of merely managing symptoms. The treatment works by reducing amyloid plaques that form in the brain—a defining pathophysiological feature of the disease. Consequently, this represents the first verified treatment showing that targeting the disease process itself produces clinical benefit.
At the molecular level, lecanemab functions by selectively binding to harmful amyloid aggregates in the brain. These amyloid aggregates that damage neurons and impair memory function. What makes this treatment distinctive is its binding affinity; lecanemab attaches to small protofibrils with 100 times greater affinity than other treatments like aducanumab. Moreover, it binds to large protofibrils with 25 times higher affinity.
The treatment is administered intravenously every two weeks. After 18 months of treatment, clinical trials showed that participants' average amyloid levels dropped below the threshold for amyloid positivity. This reduction translated to slowing cognitive decline by 27% compared to placebo. Interestingly, the drug also reduced markers of neurodegeneration, and neuroinflammation.
Notably, lecanemab is exclusively approved for adults with mild cognitive impairment or mild dementia due to Alzheimer's disease who have confirmed amyloid pathology. The treatment is not suitable for people with moderate or advanced Alzheimer's disease.
Despite its therapeutic promise, lecanemab presents significant considerations for patients and healthcare systems. The most serious side effects include brain swelling or bleeding affecting approximately 20% of clinical trial participants. Although most cases remain asymptomatic, 1-2% of patients experience serious symptoms including headache, seizures, delirium, vision problems, and muscle weakness.
Genetic factors play a crucial role in risk assessment. Individuals carrying the APOE e4 gene face substantially higher risks—32.6% compared to just 5.4% for non-carriers. Health Canada recommends genetic testing before initiating treatment with Lecanemab.
The medication requires intensive monitoring—patients need an initial brain MRI followed by four additional scans during the first year of treatment. This creates practical obstacles, particularly given Canada's imaging constraints. Indeed, people in rural or remote areas may need to travel significant distances to access MRI facilities.
Financial considerations further complicate access. Lecanemab costs approximately CAD 36,924.05 annually, a substantial expense likely creating a two-tier access system. Although private insurance may cover costs for some patients, others will depend on future public funding decisions. Nevertheless, advocates suggest long-term savings through delayed disease progression might ultimately justify these expenses.
Lecanemab represents a watershed moment in Alzheimer's treatment across Canada. This groundbreaking therapy offers meaningful hope for patients by targeting the root causes of the disease rather than merely addressing symptoms. The clinical evidence demonstrating a 27% reduction in cognitive decline certainly marks a significant advancement in the battle against this devastating condition.
