Canada’s Drug Agency recommends funding lecanemab for early-stage Alzheimer’s disease

TORONTO — Canada’s Drug Agency has recommended that public drug plans pay for a treatment shown to slow the progression of early-stage Alzheimer’s disease if patients meet certain conditions.

The decision on lecanemab — an antibody that targets the buildup of amyloid plaque in the brain, which is believed to be an underlying cause of the disease — was released Thursday.

It was a reversal of the agency’s previous decision issued in February, which recommended against publicly funding the treatment due to concerns about its effectiveness and possible side effects of brain swelling or bleeding.

Health Canada had approved lecanemab last October for adult patients with mild cognitive impairment or mild dementia due to Alzheimer’s disease, who had confirmed amyloid protein in the brain and did not have two copies of the ApoE4 gene, which has been associated with a stronger likelihood of side effects.

In an email, a spokesperson for Canada’s Drug Agency said the reconsideration of its recommendation at the request of the drug’s manufacturer, Eisai, shows the agency “is working to be agile and responsive to new and emerging evidence.”

“In this case, the re-examination of the product with longer-term data provided by the drug manufacturer supported a recommendation that the drug be reimbursed in some circumstances.”

The agency’s expert committee noted in the new recommendation that it may have underestimated lecanemab’s “clinical meaningfulness” in its previous decision.

It said they recognized patients with early Alzheimer’s disease “are faced with a progressive and ultimately debilitating condition for which there are limited treatment options.”

“The committee discussed patient autonomy in making informed decisions about treatment in consultation with their health-care team regarding the potential benefits and risks,” the recommendation said.

Christina Scicluna, CEO of the Alzheimer Society of Canada, said this first step in a possible path to public funding is “incredibly hopeful” for people living with the disease and their loved ones.

“Ultimately, access to treatments like lecanemab are giving hope for the promise of delaying the progress of the disease,” she said in an interview Thursday.

“What people know is that this is not a cure, but what it means is more time. And that’s what matters the most.”

Clinical trials showed that lecanemab, also known by its brand name Leqembi, delayed progression from mild symptoms to more debilitating dementia by about five to seven months.

“Some people may not consider that important but many people say, ‘if it means I’m more independent for longer, that’s important to me,'” said Dr. Michael Borrie, medical director of the Aging Brain and Memory Clinic at St. Joseph’s Health Care London.

Borrie was also a site investigator for Eisai’s clinical trial of lecanemab and said he had “one or two participants who have continued (on the medication) long-term after the trial.”

He also has patients who are currently paying out of pocket to get the treatment, which is given intravenously every two or four weeks.

It costs more than $30,000 per year, Borrie said, and most of his patients can’t afford that.

“As soon as I mention that figure, they say this is not even an option for us. They don’t even consider it. So it automatically excludes most of the people we’re seeing.”

Dr. Howard Chertkow, a neurologist and scientific director for the Kimel Family Centre for Brain Health and Wellness at Baycrest in Toronto, said cost has been part of the conversation he has with patients who might benefit from lecanemab.

“Quite frankly, as a physician, there’s nothing less palatable than having to take a financial history from patients. That’s not what the Canadian health system is supposed to be about,” said Chertkow, who has been paid to sit on advisory boards for Eisai but does not receive any salary support from the company.

Now that the drug agency has recommended public funding, the next step is for the pan-Canadian Pharmaceutical Alliance to negotiate a price with Eisai on behalf of government health plans.

Chertkow hopes the recommendation, along with a lower price, will also encourage private insurance companies to pick up the tab for people who have coverage.

To be eligible for lecanemab, patients must have only mild cognitive impairment or mild dementia, have amyloid protein confirmed by a brain scan or cerebrospinal fluid analysis and get regular MRIs to check for any signs of brain swelling or bleeding.

If a patient’s condition worsens from mild to moderate dementia, the drug should no longer be covered, the recommendation said. Studies have only shown lecanemab to be effective in early-stage Alzheimer’s disease.

Borrie said the most common symptom of mild cognitive impairment is forgetfulness in short-term memory, but patients are still able to live their lives and do most daily activities, although it may take them a little longer. Many people with mild cognitive impairment continue to be able to work.

When dementia progresses to the moderate stage, daily living tasks such as dressing, grooming, bathing or dealing with finances become impaired, he said.

Some dementia experts say it’s important to put the potential side effects of brain swelling or bleeding into context.

“Eighty-five per cent of people who have side effects are unaware that those side effects are occurring,” Borrie said. “They’re only detected on the MRI brain scans.”

Bleeding is usually mild and happens as part of the process of clearing away amyloid plaque, he said.

In most cases, the issue resolves and patients can continue treatment.

The microbleeds can expand and cause stroke-like symptoms, but that is rare, Borrie said.

Once the financial barrier to taking lecanemab is removed, conversations between doctors and patients can focus on the potential benefits versus the risks, said Dr. Jennifer Watt, a geriatrician at Unity Health Toronto.

Some patients will want to try it and be comfortable with the potential side effects, she said.

Other patients may be more risk-averse or just not want to take another medication.

“Sometimes the patient will also bring like a family or friend caregiver with them. And so engaging in that shared decision-making conversation with a patient and the people who they want to make that decision with (is important),” Watt said.

But for lecanemab to be on the table at all, more early detection of dementia needs to happen, said Scicluna from the Alzheimer Society.

“There’s still a lot of stigma related to Alzheimer’s disease. There’s still lot of belief that this is a normal part of aging,” she said.

“We won’t even get to the stage that this treatment is going to be an option if more people are not getting an early diagnosis.”

This report by The Canadian Press was first published July 16, 2026.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

Nicole Ireland, The Canadian Press