The Current - Health Canada approves new Alzheimer’s drug

Episode Date: October 30, 2025

Lecanemab is a new drug that’s being made available in Canada to slow the early stage of Alzheimer’s disease. We speak to Linda McMaster, who is on the waitlist to receive it. And Drs Sandra Cohen and Samir Sinha about the efficacy, cost and reality of how this new drug fits in with the wider Alzheimer’s care environment in Canada today.

This ascent isn't for everyone. You need grit to climb this high this often. You've got to be an underdog that always over-delivers. You've got to be 6,500 hospital staff, 1,000 doctors, all doing so much with so little. You've got to be Scarborough. Defined by our uphill battle and always striving towards new heights. And you can help us keep climbing.

Donate at lovescarbro.cairbo. This is a CBC podcast. Hello, I'm Matt Galloway, and this is the current podcast. It's a disease often called The Long Goodbye. More than 700,000 Canadians are living with Alzheimer's and other forms of dementia. Now, a new Alzheimer's drug has been approved by Health Canada. It's a treatment, not a cure, but it can slow the progression of the disease. Few people may qualify, and it's costly.

But for those with family suffering or who are facing the disease themselves, it can offer hope. Linda McMaster is the executive director of Art Barn School in Toronto. She's 71 years old and was recently diagnosed with Alzheimer's. She's on the wait list for the new drug. Good morning, Linda. Good morning, Catherine. What was it like when you were diagnosed with Alzheimer's?

I was devastated. It was the most terrible conversation of my life that hearing that bad news. but I realize now that I'm very fortunate because the new drug will be in operation soon. We'll be seeing people getting infused in clinics like the Menry Clinic. I'm very hopeful for that process and I'm, you know, I'll roll up my sleeve right away for it. Certainly I'm grateful. I'm grateful that finally there's an answer for this. affliction. And you do see this as an answer, even though it provides, I guess, some amount of delay

of symptoms, a few months' time. But it is, it's very important to you? Yes, it is. I think any kind of reprieve from, you know, what might happen would be welcome. So, yeah, I'm very, very hopeful that this will be good for me and for others. We're in the same situation. How are you managing the disease right now? I find that I'm on another pill that's low dose that seems to keep my mind quite clear all day long. I'm functioning and doing what I normally do. And yeah, so right now it's just, it's always there, but it's not stopping me from doing what I do.

Which is running an art school. I mean, I imagine there's no small amount of work involved in that. Well, I do have help for sure. I have a wonderful assistant, Kaya. And, you know, we're actually planning a big fundraiser coming up because the school is turning 20 years old. So 20 years ago, I started this small project in a church basement and now it's grown. So there's lots to celebrate here. You're grateful. That's wonderful. I do want to ask you a bit more about this treatment.

You're on the wait list right now for Lecanimab. How were you tested to know if you were a candidate for this drug? They had to do a spinal tap on me to get the fluid that they needed to diagnose it. And that was done in Amsterdam, as I recall. So the procedure was not painful. It was, you know, it was, I just, it was quick. It was not painful. So it was not a big deal.

And the fluid just went and got tested in Amsterdam. What are your doctors able to tell you about how long you might be on this wait list? I haven't heard anything yet about, you know, about the wait list in particular. So I'm sure they will tell me when the time is come. There are challenges that come along with this treatment, too, in the sense that we know the cost in the United States is incredibly expensive. Yes, it is. $26,000 a year. I know.

Does that, I mean, that's a lot of money. Does that make you hesitate? No, I'm very fortunate. That would not be an, would not impede my participation. There's also, it has to be taken intervenously. There are scans you have to do to ensure, you know, keep an eye on any potential side effects. Why is it worth it for you to potentially go to the expense and, you know, the demands, I guess, of this treatment? What does it, what would it mean for your life to your mind? I think, I think it's very important to my life and the way I, the way I function, and yes, I welcome these interventions. I think that this is what needs to be done. I'm not going to be the only one doing this, that's for sure. There's such a backlog of people that need help. So, yeah, I'm grateful that I can maybe, you know, have a chance at a normal life,

which right now I seem to be in a good state. And so things. are, things are good. And what is it like waiting? I'm fine with that. I know the challenges that they face to get this clinical stuff going and the drug itself. So I'm patient. I'm a patient patient. Well, listen, Linda, it was really nice to meet you on the radio.

Congratulations on 20 years of your art school. And I wish you and your family all. all the best. Okay, Catherine, good talking to you this morning. You as well. Linda McMaster is the executive director of Art Barn School in Toronto. As you heard, she is on the wait list for the new Alzheimer's drug, Lacanamab. This ascent isn't for everyone. You need grit to climb this high this often. You've got to be an underdog that always overdelivers. You've got to be 6,500 hospital staff, 1,000 doctors, all doing so much. with so little.

You've got to be Scarborough. Defined by our uphill battle and always striving towards new heights. And you can help us keep climbing. Donate at lovescarbro.cairbo.cair. The headlines never stop and it's harder than ever to tell what's real, what matters, and what's just noise.

That's where POTSafe America comes in. I'm Tommy Vitor and every week I'm joined by fellow former Obama aides John Favro, John Lovett, and Dan Pfeiffer to break down the biggest stories, unpack what they mean for the future of our democracy, and add just enough humor to stay sane along the way. You'll also hear honest, in-depth conversations with big voices in politics, media, and culture,

like Rachel Maddo, Gavin Newsom, and Mark Cuban that you won't find anywhere else. New episodes drop every Tuesday and Friday with deep dives every other weekend. Listen wherever you get your podcast, watch on YouTube, or subscribe on Apple Podcasts for ad-free episodes. There's hope and excitement, as Linda just expressed, but questions around the drug's efficacy and cost. Dr. Sharon Cohen is a behavioral neurologist and the medical director and site principal investigator of the Toronto Memory Program. She worked on the drug's clinical trials. Dr. Samir Sinha is a geriatrician and clinician scientist at Sinai Health and the University Health Network.

He's also a professor of medicine at the University of Toronto. Good morning to you both. Good morning. Good morning. Dr. Cohen, I'll start with you. As we said, you worked on the clinical trial for Lacanamab. I mean, we just heard the hope that Linda has for this treatment. How significant is it, this moment? This moment is worth embracing. It is a milestone.

We have a large population of seniors who have or will develop Alzheimer's disease and deserve a disease slowing treatment to keep them mild as long as possible. I am a clinical trialist. I'm an Alzheimer's doctor. So I've worked on many different drug development programs, including the Lacanamap program in phase two, phase three, the pivotal trial that led to approval in multiple countries and now in Canada. And I'm also very active in the prevention study, going even earlier in people who are still cognitively normal, and we're very hopeful about that. So this drug has been demonstrated to slow the decline in cognition, slow the decline in function. It has absolutely shown that.

And I think any quibbles about how effective are really resulting from, number one, a lack of understanding of what the data shows. And number two, holding Alzheimer's disease to a different standard than we hold other diseases like cancers and rheumatoid arthritis. I want to bring Dr. Sinai in a second, but I just want to ask you, Dr. Cohen. She said this will, I want to have a chance at a normal life. Is that what Lacanamab gives patients? So what it gives patients is an opportunity to stay in the early stages of Alzheimer's disease much longer than they would otherwise. So you can hear from Linda, she's very well-spoken, she's functioning well.

I know her. She's a patient in our clinic. She is, you know, running an art school, as you heard. And to keep her at this level at home doing the things that are meaningful to her is so important. And it's the later stages of the disease that are particularly disabling and distressing, having to leave one's home, go to a nursing home, having family members have to look after you, dress you. This is what people fear with Alzheimer's and keeping her mild, what she calls a normal life. Yes, she's got some memory problems, but she's managing. This is very realistic. What we're seeing out to the four-year long-term extension data with the pivotal study is that people are gaining time in the order of a year.

So, you know, much longer period of staying mild. And that's still good quality of life when you're in the mild. stage of disease. Dr. Sinha, how do you see this development? You know, as Dr. Cohen is saying, right, this is the first treatment that has become available in, you know, that I know of, you know, that has been, that has been actually shown to actually delay the progression of Alzheimer's dimension. So that is, as Dr. Cohen says, this is a milestone. But I think the challenge with this medication is, well, it's very, very effective at clearing away this amyloid plaque, you know, this, what we've looked at as

being a significant cause or related to dementia, Alzheimer's dementia in particular. What we haven't actually seen is as significant, you know, an impact on people's functioning. So certainly it can slow the progression. Certainly it can improve functioning, but we're not necessarily seeing it, improve it, to the levels that we hoped it would have been. So this is a positive development. It certainly is going to be beneficial for some people, but when you look at the cost that it, you know, that people will incur, you know, a number of jurisdictions like the NHS in Britain, for example, and other jurisdictions have looked at this and said, look, you know, while there are positive benefits from a medication like this, is it going to have enough

of a meaningful clinical benefit, is it going to have enough of a benefit that makes it worth covering under our publicly funded programs? And I think that's the challenge right now. And I think we need more data. You know, as Dr. Cohen said, there's more data coming that will hopefully kind of show us how much more of an improvement it can be. But right now, it's, you know, it's a milestone. It's an opportunity. But I don't necessarily know. that it's going to, it's not necessarily the breakthrough. And that's the thing that I fear most right now is people are so desperate for cures, so desperate for treatments. I think this is another option, but I don't think this is the revolution that we all hoped it would be.

Do you foresee yourself prescribing it to many patients, Dr. Sinha? It's certainly something that as a geriatrician, when I diagnose people with mild cognitive impairment or with mild Alzheimer's dementia, I'm going to mention it. I'm going to let them know, but I'm also going to let them know kind of what I've interpreted from the results that while it can certainly show that it can actually slow this, you know, there's another medication that's been around for a long time that Dr. Cohen and I prescribe as well. But again, we talk about, you know, is this going to be the benefit that will benefit

this patient when you get into later stage? of what we call mild dementia as opposed to mild cognitive impairment, seen as a bit of a precursor, you know, the gains aren't as significant, for example. We're also seeing right now that women, for example, in some of the subgroup analyses, don't perform as better as men in these studies, you know, that sometimes the benefits are four times greater for men than women. And when we look at the overall benefits, you know, what measured with an 18-point scale, you know, we say that The progression is 1.61 versus 1.24. So they say it's a 27% benefit.

But that's, you know, like a 0.4 benefit on an 18-point scale. Now, that could mean significant improvement for some people, but for many people, we're not sure. And the process of undergoing this treatment is the regular infusions, the regular MRIs, you know, there's, and the cost. And so that's where I just, my concern right now is it's something that I'm going to mention, something I can talk about, but I know it might not be the right medication for a number of my patients. Dr. Cohen, before we get to some of the issues that Dr. Sinai is bringing up there about the challenges that come along with, I do think it's really important, given how much news like this might come across is so meaningful for people who are either have an Alzheimer's diagnosis, a loved one does. It's important to talk about who can potentially benefit from this medication.

So because my understanding from the information I've read is that while great swaths of people might hope to have access, ultimately a relatively small percentage actually are appropriate candidates for us. Can you paint a picture for who might most benefit? Sure. I'm happy to talk about who's eligible for the drug and also to respond to Dr. Sinas comments as well. So in terms of the Health Canada indication, lachanamab is appropriate for individuals. who are at the early symptomatic stages of Alzheimer's. And what does that mean? That means the mild cognitive impairment stage where people are still independent

in day-to-day function and the mild dementia stage where people may be dependent in some things. Maybe I'm not driving anymore. Maybe I'm not doing my own banking, but there are many other things I can do. Those are the two stages, so not for moderate or severe dementia. And we need to have confirmation that you actually have Alzheimer's disease as the cause of your memory or cognitive decline. And how do we do that?

Linda described having a spinal tap. Another way is to have a pet amyloid scan. And a more recent way is to have a blood test that tells us about the amyloid protein in the brain. So there are options. Okay. So you need to be at the early symptomatic stage, have amyloid confirmation,

and Health Canada has said you need to have an apolead. e genotype that doesn't show two copies of e4. So a genetic test will also be required. There's some other details, but those are the broad. That's the big picture. I know you want to address the concerns of Dr. Sankaray, so let's get into that. Sure. Thank you for the opportunity. So I understand that some of my colleagues feel that this may not be such a big deal in terms of efficacy. But what we saw in the pivotal studies is not just lowering of amyloid very robustly as early as three months. We see a dramatic decline in the amount of amyloid in the brain, and that continues out to 18 months duration of the study. But we also see steady and expanding magnitude of benefit to

cognition, to daily function, and importantly, to quality of life as rated by patients themselves and care partner burden as rated by care partners. And the magnitude is not trivial. When Dr. Sina talks about an 18-point scale, he's referring to something called the CDR sum of boxes, but the 18 points is not really relevant in the early stage of Alzheimer's disease. Patients are coming in at a staging of, you know, two points

and will over 18 months, you know, progress untreated. So this is, I'm just going to jump in, Dr. Cohen, because I do think it's an important point to emphasize. This is not, in fact, people getting better, though, right? It is people getting worse, more slowly. That's a really good point. So the drug has shown its ability to slow disease, to act as a disease modifying drug. So that means slowing down, you're right. But what we've also seen with new data and data presented as early, as recently as July at a major conference,

AIC in Toronto, is that the earlier you start, the more opportunity, not just not to decline, but some people will actually improve. And this is really more than we hope for with a drug like Lecanimap, because yes, the goal is to keep people stable longer to slow the decline, and we are absolutely doing that. But if you start at a biologically earlier stage of Alzheimer's, if you catch the disease with less amyloid accumulation than the average, you can actually stay stable or improve, and we're seeing that out to four years. That's remarkable.

And I think when we think of Linda wanting to see her grandchildren, wanting to continue her art school, we had now data out to four years that people can actually be stable or improved. Dr. Sinho, we have a minute left, and I do want to ask about the bigger picture here. What is the most important thing needed in Canada right now to better help patients and their caregivers? You know, I think the challenge is that we don't have a strong enough health care system overall with the right access points so people can get early diagnosis and management of these things. And we need to do a lot more work so people can have opportunities like this.

But even the bigger picture is that there's a lot of things that we're not promoting and, you know, as a public health system to remind people that there are things that people can do. There's good evidence that there are things people can do like managing blood pressure, fixing curing, managing diabetes that can help prevent even the onset, you know, prevent or delay the onset of dementia in the first place. And so I think we have to contextualize it in the broader pieces here is that this is going and be a medication that will be helpful for some. But we also, there's lots of other things

we need to be doing to better prepare our country to help, A, reduce the number of people living with dementia in the first place, and then making sure that those who may have dementia can get early diagnosis and timely management. Right now, we're not well prepared, and we've got to do it so that if there are opportunities like this that improve and show greater evidence and their effectiveness, that our system will cover it and make it more widely available and accessible, most importantly, to people who would benefit from it. Okay. Thank you very both. Thank you both very much for your insights today. Appreciate it. You're very welcome. Thank you. Thank you. Thank you, Karen.

Dr. Sharon Cohen is a behavioral neurologist and the medical director and site principal investigator of the Toronto Memory Program. She worked on Lacanamab's clinical trials. And Dr. Samir Sinha is a geriatrician and clinician scientist at Sinai Health and the University Health Network. He's also a professor. of Medicine at the University of Toronto. You've been listening to the current podcast. My name is Matt Galloway. Thanks for listening.

I'll talk to you soon. For more CBC podcasts, go to cbc.ca.ca slash podcasts.