Accessing treatment with lecanemab (Part 3 of 3-part series)

Treatment options for Alzheimer's

Part 3 : What else do I need to know about eligibility and how to access treatment? 

Lecanemab was proven effective at reducing Alzheimer’s-type plaques in the brain. Amyloid is measured in the brain using a specialized type of scan called amyloid PET. Research participants all had an amyloid PET scan showing evidence of these plaques before starting treatment. This scan was needed to prove that Alzheimer’s disease caused their cognitive impairment and that the drug disrupted plaque formations. This type of scan is not readily available in most of Canada. We do not know yet if proof of plaques on PET amyloid scanning will be a requirement for eligibility to receive treatment.  

An alternative biomarker of Alzheimer’s disease comes from measuring the concentration of certain peptides in the fluid that surrounds the brain and spinal cord. This process involves inserting a needle in the lower spine to collect a sample of the fluid.  Many doctors, including those outside of major cities, do not have access to lumbar punctures. So, for the moment, availability of this test for eligibility is limited.

A gene variant called ApoE-4 puts people at higher risk of developing Alzheimer’s disease. People with two copies of this gene variant are at the highest risk for Alzheimer’s compared to those with one copy, and no copies is associated with lowest risk. People with two copies of the ApoE-4 gene should not take lecanemab because it was associated with higher instances of brain swelling and bleeding in this group of research patients. Patients who took part in research on lecanemab had regular MRI scans to monitor for side effects, so that treatment could be stopped before causing additional harm.

Genetic testing for ApoE-4 is not part of standard health care. It is used for research and is sometimes requested by people with a family history of Alzheimer’s who want to better understand their personal level of risk. Genetic testing will be required to determine if a patient is eligible for treatment with lecanemab. More capacity must be built to manage the increase in demand for genetic testing brought about by this new treatment.

Other health indications may also affect eligibility for treatment with lecanemab. For example, many older adults are prescribed blood thinners to reduce their risk of stroke. These medications can also increase the risk of brain bleeding as a side effect of lecanemab. Treatment with lecanemab may not be recommended for people taking these medications.

Finally, the province of Quebec is responsible for deciding whether treatment with lecanemab will be funded through the public health care system, or whether patients will need to pay out-of-pocket for the tests and procedures associated with this treatment. Decisions of this nature are made by the Quebec Minister of Health and Safety, based on review and recommendations made by the Institut national d'excellence en santé et en services sociaux (INESSS). This process can take up to two years, and do not always conclude in favour of covering the costs of a treatment through the public system.

In conclusion, a cure for Alzheimer’s is now in sight but not yet within our grasp.  Science has provided us with a potential solution. It now rests in the hands of health-care providers, the public health-care system, and individual patient choices to determine how soon we can begin to benefit from this new therapy.