Potential breakthrough drugs for dementia and Alzheimer's face uncertain delays in Canada

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As many as 747,000 Canadians currently live with at least one form of dementia, including Alzheimer’s disease. Living with this type of disease takes a significant toll on both the person who develops it and their families.

Dr. Andrew Frank, a Cognitive Neurologist with Bruyere Health Memory Clinic in Ottawa, Ont., sees patients first-hand and notes just how devastating the disease can be because of how “it takes away someone’s independence and their personhood.”

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“So many individuals and their families are negatively affected, and the incidence and prevalence are increasing around the world because of the aging population,” said Dr. Frank.

Current treatments available in Canada do very little to stop the progression of the disease, as there have been very few options that were able to do that. Therapies now revolve around managing symptoms, and for the last two decades since their inception, that was all that people with Alzheimer’s had.

But that all might be about to change. Health Canada is currently reviewing two new disease-modifying drugs, lecanemab and donanemab, that could slow the disease down if taken in the early stages, allowing people with Alzheimer’s and dementia to have up to 10 more months of cognitive function and independence. These drugs, which are already available in 44 countries worldwide, could mark significant progress in treating dementia and Alzheimer’s in Canada.

Dawn of disease-modifying drugs for Alzheimer’s and dementia

The two new medications that Health Canada is reviewing fall under the category of disease-modifying drugs. These drugs are designed to slow the progression of certain diseases, stop it from worsening, or reverse it.

In the specific case of lecanemab and donanemab, they aim to slow down progression by targeting the buildup of amyloid plaques, which is what researchers believe plays a significant role in the development of Alzheimer’s disease.

This breakthrough acts as a crucial point in Alzheimer’s treatment.

“There is standard treatment across the world with what are called cholinesterase inhibitors,” said Dr. Frank. “We’ve used them for the past 25, almost 30 years now as a symptomatic treatment for Alzheimer’s and they can help memory a little bit, but do not address what we believe or understand to be the underlying chemistry of Alzheimer’s disease, which is the buildup of the amyloid protein and the Tau protein.”

By being able to tackle the underlying issue, researchers and medical professionals who work with dementia patients can finally provide people living with dementia more time. That said, access to these drugs is not yet available in Canada.

Canada falls behind the pack

The result of Health Canada’s review is not yet available, so it’s still up in the air whether they will approve the drugs or not. They have all the information they need to go on, but because there have been certain serious side effects associated with taking these medications, the decision to make them freely available isn’t an easy one.

“They have been associated with swelling in the brain and bleeding in the brain, which sometimes causes no symptoms, but sometimes can cause significant symptoms like headache, confusion, dizziness, or at worst, stroke-like symptoms,” said Dr. Frank. “In rare cases, (these side effects) have been permanent stroke-like symptoms or even fatal.”

Even so, the therapies have proven to be effective at slowing down progression in dementia and Alzheimer’s by roughly 27 to 35 per cent, which Dr. Frank notes is “good, which is something,” considering the current lack of viable treatments that work by addressing the root cause.

“So that is the crux of the discussion, that while there is a breakthrough here and progress in an area of medicine which is so in need of progress, there is perhaps a benefit that may not be balanced by its potential risk,” he said. “However, across the world, these medications have been approved, given some of the risk mitigation strategies that we have employed.”

To monitor and reduce the risk of side effects becoming a worse-case scenario, MRI surveillance has been introduced in other countries that have approved the drug, as well as genetic testing to determine if a person is more likely to have brain swelling or bleeding because of their genetic makeup. If a person’s genes make them high-risk, they are unable to qualify for the drug.

Giving people the right to medical autonomy

While the side effects that can develop from these medications can be severe or even life-threatening, Alzheimer’s and dementia in and of themselves threaten a person’s life in a different way. It erodes their independence and sense of self over time, leaving them without a life at all.

So, it begs a question. What’s worse? The potential risks of the medication, or not having access to a medication that could, in many cases, provide people with Alzheimer’s more time to live.

According to Dr. Frank, Health Canada’s approval is necessary because people living with the disease and their families have the right to make their own decisions regarding care.

“Some individuals may want this treatment knowing that they’re facing a significant illness like Alzheimer’s and that they face decline in their memory and functioning in the future, they may wish to proceed with treatment despite the risks and the burden,” said Dr. Frank.

“The word autonomy is perfect in this context in that I support patient and family autonomy to make their own decision on the benefits and the risks of the new anti-amyloid therapies for themselves and their families.”

Dr. Frank notes that he is “disappointed” that Health Canada has lagged on approving the medicine, leaving patients to lie in wait as their disease continues to worsen, knowing that there’s something out there that could help. He hopes that approval will come over the next year for Alzheimer’s patients and their families, many of whom have already asked him about anti-amyloid therapy in his clinic.

In the meantime, he urges people to always be aware of their cognitive health and memory as they get older because if or when these drugs are available, “those at the mildest stage get more benefit from these treatments.”