Opinion: Canada is falling behind on treatments for Alzheimer's disease
Op Eds
Alzheimer's disease is an insidious and relentless loss of memory and thinking, accompanied by a gradual yet devastating deterioration in ability to function independently. It's a terrifying diagnosis for patients and families alike.
Dementia is defined as a loss of memory or thinking, which takes away daily independence. Alzheimer's disease is the buildup of amyloid and tau proteins in the brain — proteins that begin as helpful, yet become toxic as they accumulate. Alzheimer's disease is therefore the cause, and dementia is the effect.
Unfortunately, medical treatments for Alzheimer's disease and dementia have remained minimal for over 25 years, and with a growing aging population, Alzheimer's disease has become one of the greatest unmet medical needs in the world.
There is hope on the horizon.
Recently, two new intravenous medications, lecanemab and donanemab, have shown they can clear away toxic accumulations of the amyloid protein in Alzheimer's disease. One or both of these medications have been approved in the United States, European Union, United Kingdom, China, Japan, Mexico, Brazil and Australia. Yet they have not been approved in Canada.
Canada is falling behind, and families are suffering. We need to make new Alzheimer's disease medications available to Canadians in a timely and accessible manner.
Clinical trials researching lecanemab and donanemab demonstrated a 27 to 35 per cent slowing of cognitive decline in individuals with Alzheimer's disease versus a placebo, with greater benefit experienced the earlier in the disease process the treatment was started. The treatments slow the rate at which Alzheimer's disease worsens, though they do not fully stop or reverse the damage.
Both lecanemab and donanemab remain under review by Health Canada and are not yet approved for use in Canada. The decision to approve these medications has been complex, as a slowing of cognitive deterioration by 27 per cent may not be viewed as enough of a benefit, especially when weighing against potential side-effects.
Indeed, as these medications cross into the brain and trigger clearance of amyloid by the immune system, there can be development of swelling or bleeding in the brain. While most clinical trial participants who developed swelling or bleeding had no associated symptoms, three to six per cent experienced headache, dizziness, confusion or occasionally stroke-like symptoms. Often these symptoms were resolved when treatment stopped, though in rare cases they were permanent.
In some ways, arrival of these medications ushers in a new era of Alzheimer's disease treatment, reminiscent of the approach we now take toward cancer: detection of disease at the earliest possible stage, and potential treatment with medications capable of serious side-effects.
Canadians who have Alzheimer's disease deserve the chance to evaluate the potential benefits and side-effects of these new medications, to determine, for themselves and their families, if they wish to proceed to treatment. The decision process must include fully informed consent, guided by real-world results from patients across the world.
Patient registries — collections of anonymous patient data — play a critical role in tracking benefits and side-effects of new medications over time. A registry for those treated with new Alzheimer's disease medications in Canada would be essential.
At the end of July, Canada will welcome the global Alzheimer's disease clinical and research community to the Alzheimer's Association International Conference, held in Toronto this year. The message will be clear: Canada should provide the same treatment opportunities to its citizens as other jurisdictions around the world.
The memories and autonomy destroyed by Alzheimer's disease continue to make it one of the greatest health challenges faced by Canadians. New anti-amyloid treatments are not a cure, though they represent desperately needed progress. They also represent hope that we will one day live a long and full life without the ravages of dementia.
A long and full life, for ourselves and those we love.
Dr. Andrew Frank is a cognitive neurologist at Bruyère Health and investigator at Bruyère Health Research Institute in Ottawa.
Katherine C. Pearson is a professor of law and Arthur L. and Sandra S. Piccone Faculty Scholar at Dickinson Law, Pennsylvania State University, and the 2024-25 visiting research fellow at the University of Ottawa's Centre for Health Law, Policy and Ethics.
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Op Eds Alzheimer's disease is an insidious and relentless loss of memory and thinking, accompanied by a gradual yet devastating deterioration in ability to function independently. It's a terrifying diagnosis for patients and families alike. Dementia is defined as a loss of memory or thinking, which takes away daily independence. Alzheimer's disease is the buildup of amyloid and tau proteins in the brain — proteins that begin as helpful, yet become toxic as they accumulate. Alzheimer's disease is therefore the cause, and dementia is the effect. Unfortunately, medical treatments for Alzheimer's disease and dementia have remained minimal for over 25 years, and with a growing aging population, Alzheimer's disease has become one of the greatest unmet medical needs in the world. There is hope on the horizon. Recently, two new intravenous medications, lecanemab and donanemab, have shown they can clear away toxic accumulations of the amyloid protein in Alzheimer's disease. One or both of these medications have been approved in the United States, European Union, United Kingdom, China, Japan, Mexico, Brazil and Australia. Yet they have not been approved in Canada. Canada is falling behind, and families are suffering. We need to make new Alzheimer's disease medications available to Canadians in a timely and accessible manner. Clinical trials researching lecanemab and donanemab demonstrated a 27 to 35 per cent slowing of cognitive decline in individuals with Alzheimer's disease versus a placebo, with greater benefit experienced the earlier in the disease process the treatment was started. The treatments slow the rate at which Alzheimer's disease worsens, though they do not fully stop or reverse the damage. Both lecanemab and donanemab remain under review by Health Canada and are not yet approved for use in Canada. The decision to approve these medications has been complex, as a slowing of cognitive deterioration by 27 per cent may not be viewed as enough of a benefit, especially when weighing against potential side-effects. Indeed, as these medications cross into the brain and trigger clearance of amyloid by the immune system, there can be development of swelling or bleeding in the brain. While most clinical trial participants who developed swelling or bleeding had no associated symptoms, three to six per cent experienced headache, dizziness, confusion or occasionally stroke-like symptoms. Often these symptoms were resolved when treatment stopped, though in rare cases they were permanent. In some ways, arrival of these medications ushers in a new era of Alzheimer's disease treatment, reminiscent of the approach we now take toward cancer: detection of disease at the earliest possible stage, and potential treatment with medications capable of serious side-effects. Canadians who have Alzheimer's disease deserve the chance to evaluate the potential benefits and side-effects of these new medications, to determine, for themselves and their families, if they wish to proceed to treatment. The decision process must include fully informed consent, guided by real-world results from patients across the world. Patient registries — collections of anonymous patient data — play a critical role in tracking benefits and side-effects of new medications over time. A registry for those treated with new Alzheimer's disease medications in Canada would be essential. At the end of July, Canada will welcome the global Alzheimer's disease clinical and research community to the Alzheimer's Association International Conference, held in Toronto this year. The message will be clear: Canada should provide the same treatment opportunities to its citizens as other jurisdictions around the world. The memories and autonomy destroyed by Alzheimer's disease continue to make it one of the greatest health challenges faced by Canadians. New anti-amyloid treatments are not a cure, though they represent desperately needed progress. They also represent hope that we will one day live a long and full life without the ravages of dementia. A long and full life, for ourselves and those we love. Dr. Andrew Frank is a cognitive neurologist at Bruyère Health and investigator at Bruyère Health Research Institute in Ottawa. Katherine C. Pearson is a professor of law and Arthur L. and Sandra S. Piccone Faculty Scholar at Dickinson Law, Pennsylvania State University, and the 2024-25 visiting research fellow at the University of Ottawa's Centre for Health Law, Policy and Ethics.
