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Lecanemab (Leqembi®) in Early Alzheimer’s Disease: A Clinical Guide for Family Physicians in Canada

Teaser: 

D'Arcy Little MD CCFP FCFP FRCPC,

D’Arcy Little, MD, CCFP, FCFP, FRCPC, Medical Director, Journal of Current Clinical Care and www.healthplexus.net Radiologist, Orillia Soldiers’ Memorial Hospital, Assistant Professor, Department of Medical Imaging cross-appointed to Department of Family and Community Medicine, University of Toronto, University of Toronto, Toronto, ON.

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Abstract:
Lecanemab (Leqembi®), approved by Health Canada in October 2025, represents Canada’s first disease-modifying therapy for Alzheimer’s disease. This guide reviews patient selection criteria, including mandatory APOE genotyping and amyloid biomarker confirmation, for adults with mild cognitive impairment or mild dementia due to Alzheimer’s disease. Key safety considerations include amyloid-related imaging abnormalities (ARIA), requiring rigorous MRI surveillance protocols. Family physicians play essential roles in early identification, coordinating pre-treatment workups, monitoring for adverse events, and providing collaborative care throughout treatment.

Key Words: Lecanemab, Alzheimer’s disease, amyloid-related imaging abnormalities (ARIA), APOE genotyping, disease-modifying therapy.
Patient Selection: Indicated for adults aged 50-90 with MCI or mild dementia due to Alzheimer’s disease, confirmed amyloid pathology (PET or CSF), and MMSE 22-30. APOE ε4 homozygotes excluded due to elevated ARIA risk.
Pre-Treatment Requirements: Mandatory APOE genotyping, amyloid confirmation, and baseline MRI. Patients with ≥5 microbleeds, macrohemorrhage, superficial siderosis, or anticoagulant use are excluded.
ARIA Monitoring: Imaging abnormalities occur in 13% (edema) and 17% (hemorrhage) of patients, mostly asymptomatic. MRI surveillance required at weeks 4, 8, 12, 26, and 52.
Clinical Efficacy: 27% relative reduction in cognitive decline at 18 months, representing approximately 4-5 months of delayed progression compared to placebo.
NO tPA with ARIA: Patients presenting with stroke-like symptoms should NOT receive thrombolytics until ARIA excluded by MRI. Always alert emergency personnel to lecanemab treatment status.
Anticoagulation Excludes Treatment: All anticoagulant therapy is contraindicated. Review antiplatelet medications during pre-treatment assessment.
ARIA is Usually Silent: 75-80% of cases are asymptomatic. Maintain high suspicion for headache, confusion, or visual changes in first 3 months when risk peaks.
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Related Terms: Radiology, Lecanemab, Alzheimer, amyloid-related imaging abnormalities (ARIA), APOE genotyping, disease-modifying therapy
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Caring for Patients and the Planet: Strategies for Sustainable Primary Care

Teaser: 

Kelachi Nsitem, MSc (Clin Epi), MD Candidate,1 Sean D Christie, MD, FRCSC,2

1McMaster University, Class of 2028
2Head, Division of Neurosurgery and Sustainability Leader, Dalhousie University and Nova Scotia Health.


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Abstract: Primary care plays a pivotal role in reducing healthcare’s environmental footprint while maintaining high-quality, patient-centred care. Clinician decisions regarding diagnostic testing, medication and operational workflows directly and indirectly influence resource use, carbon emissions and overall planetary health. This paper explores strategies to promote sustainable primary care, organized into clinical and non-clinical domains. Clinical interventions include minimizing low-value care and adopting appropriate, environmentally-conscious prescribing practices. Non-clinical approaches focus on virtual care, operational efficiency, and sustainable procurement. Tailoring strategies to practice context and team capacity enables feasible implementation, yielding benefits for both patient outcomes and environmental sustainability.
Key Words: sustainable healthcare, primary care, environmental impact, climate change mitigation, population health.

Members of the College of Family Physicians of Canada may claim MAINPRO-M2 Credits for this unaccredited educational program.

www.cfpc.ca/Mainpro_M2

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Pre-test CME Quiz Post-test CME Quiz
Hip fractures in the elderly lead to a 17–30% one-year mortality.
Primary care contributes to healthcare’s environmental footprint but is well positioned to lead sustainability efforts
Reducing low-value care and optimizing prescribing practices will improve patient outcomes and reduce care-associated emissions
Virtual care and operational modifications are practical strategies to minimize emissions from travel, energy use, and consumables
Feasibility varies by practice setting; strategies should be adapted to rural, urban, small team, and interprofessional clinic contexts
Choosing Wisely Canada recommendations support reduction of unnecessary tests and procedures.
Implementing hybrid or virtual care models reduces patient and staff travel, improving access and decreasing carbon emissions, particularly in rural populations.
Simple operational changes, such as using reusable instruments, reducing disposable gloves, and minimizing table paper, can meaningfully lower clinic environmental impact
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.
Related Terms: Back Health, sustainable healthcare, primary care, environmental impact, climate change mitigation, population health