Lecanemab arrived in Canada in January 2026 as an anti-amyloid therapy meant to slow Alzheimer disease. A new practice article in CMAJ, "Lecanemab use for early Alzheimer disease in Canada," lays out key challenges with the drug including narrow eligibility, a modest effect that may not be clinically meaningful, and a resource-intensive path to treatment.

Dr. Sophie Weiss, a co-author of the article and a third-year internal medicine resident at the University of Toronto, walks through eligibility and effect size of this novel treatment. Qualifying is a multi-step process of confirmed amyloid on a PET scan or lumbar puncture, genetic testing and a baseline MRI. However, the Clarity AD trial slowed decline by 0.45 points on a standard dementia scale, short of the roughly 1-point difference considered clinically meaningful. Patients eligible and interested in pursuing the therapy, in spite of its modest benefit, will need to pay $35,000 to $40,000 a year which presents one more barrier to treatment.

Dr. Vivian Ewa, a care of the elderly physician in Calgary and a clinical associate professor at the University of Calgary, describes the drug's limited role in her practice. She is unable to prescribe it as this is restricted to a small number of specialized prescribers. She says biweekly infusions and urban-only diagnostics put it out of reach for rural and remote patients. For the many who will not qualify, she points to the 2024 Lancet Commission finding that 45% of dementia cases are potentially preventable by modifying 14 risk factors, through such interventions as physical activity, socialization, vascular risk management and hearing correction.

For some patients, lecanemab may offer hope for a devastating condition lacking effective disease-modifying treatments. Physicians should be clear about the potential barriers, modest effect size and significant cost. At the same time, primary care physicians should emphasize the impact of reducing identified risk factors.

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