Disease-modifying drugs for Alzheimer disease: implications for people in Canada

At least 250 000 people in Canada live with mild dementia, and 1.3 million live with mild cognitive impairment. Alzheimer disease is implicated in 60%–70% of cases of dementia and 30%–77% of cases of mild cognitive impairment.4,5 There are no recommended medications for treating people in Canada with mild cognitive impairment or dementia caused by Alzheimer disease. No disease-modifying medications for the treatment of Alzheimer disease have been approved in Canada. Lecanemab was the first disease-modifying medication for Alzheimer disease to be granted full approval by the US Food and Drug Administration, and a second such medication — donanemab — is under review by the agency; lecanemab is under review by Health Canada. If disease-modifying medications for Alzheimer disease are approved by Health Canada, substantial planning at the health system level is needed to support their implementation, because of high medication costs, and a clear need for post-marketing surveillance, given limited certainty of effect from existing trial data. We discuss disease-modifying medications for Alzheimer disease that have recently been brought to market and approved for use in other jurisdictions, as these may become accessible in Canada in due course.