Alzheimer’s Drug Lecanemab Not Covered by Dutch Health Insurance

The Netherlands’ Zorginstituut, the national healthcare institute, has advised against including the new Alzheimer’s drug lecanemab (marketed as Leqembi®) in the country’s basic health insurance package. The decision, announced on February 18, 2026, stems from concerns over the drug’s limited clinical benefit and the risk of serious side effects, including brain swelling and bleeding. This news arrives as a disappointment for patients and advocacy groups who had hoped for a breakthrough treatment for the debilitating neurodegenerative disease.

Alzheimer’s disease, a progressive and ultimately fatal condition, affects millions worldwide. It’s characterized by a gradual decline in cognitive function, impacting memory, thinking, and behavior. Currently, approximately 220,000 people in the Netherlands live with Alzheimer’s, with over 800,000 family members providing care. The search for effective treatments has been ongoing for decades, with limited success.

Lecanemab’s Limited Efficacy and Serious Risks

Lecanemab is designed to target and remove amyloid plaques, abnormal protein deposits that accumulate in the brains of people with Alzheimer’s disease. While clinical trials demonstrated a small effect on slowing cognitive decline, the Zorginstituut concluded that this effect was insufficient to justify the drug’s cost and potential harms. The institute’s assessment found that patients treated with lecanemab continued to experience significant functional decline despite receiving the medication.

Perhaps more concerning are the potential side effects. Lecanemab carries a risk of amyloid-related imaging abnormalities (ARIA), which can manifest as brain swelling or bleeding. These side effects, while often asymptomatic, can sometimes lead to severe neurological complications, including paralysis, speech difficulties, and confusion. In rare cases, ARIA can be fatal. The need for frequent monitoring via MRI scans – at least five during treatment – adds to the burden on patients and healthcare resources. According to the Zorginstituut, only a small subset of patients with early-stage Alzheimer’s would even qualify for the treatment.

How Lecanemab Works and Why It Falls Short

The underlying pathology of Alzheimer’s disease remains a complex and incompletely understood area of research. The amyloid hypothesis, which posits that amyloid plaques play a central role in the disease process, has been a dominant theory for years. Lecanemab works by binding to these amyloid plaques, tagging them for removal by the body’s immune system. Though, despite the visible reduction in amyloid plaques observed on MRI scans, the drug has not demonstrated a clinically meaningful impact on the progression of the disease.

Edo Richard, a professor of dementia at Radboudumc who participated in the Zorginstituut’s consultation, described the treatment as “very burdensome due to the many hospital visits.” Each patient requires bi-weekly infusions and regular MRI monitoring to detect and manage potential side effects. This intensive treatment regimen adds significant logistical and financial strain.

Patient Disappointment and Future Outlook

The Zorginstituut’s recommendation has been met with disappointment from patient advocacy groups. While acknowledging the limitations of lecanemab, these groups express frustration over the lack of effective treatment options for Alzheimer’s disease. The decision underscores the urgent need for continued research and development of novel therapies. Mark Janssen, chairman of the Zorginstituut, stated that it was a “disappointment” that the drug did not represent a breakthrough for patients and their families, but expressed hope that more effective treatments would emerge in the coming years.

The decision by the Zorginstituut is an advisory one. the final decision on whether to include lecanemab in the basic health insurance package rests with the Minister of Health, Welfare and Sport (VWS). However, it is generally understood that the minister typically follows the recommendations of the Zorginstituut. The European Commission granted marketing authorization for lecanemab in the European Union in 2025, paving the way for its potential use in other member states.

The Broader Context of Alzheimer’s Research

The failure of lecanemab to secure reimbursement in the Netherlands highlights the challenges inherent in developing effective treatments for Alzheimer’s disease. Despite decades of research, the disease remains largely enigmatic, and many clinical trials have yielded disappointing results. Current research efforts are focused on a variety of approaches, including targeting different proteins involved in the disease process, developing immunotherapies, and exploring lifestyle interventions.

The exact causes of Alzheimer’s disease are still being investigated, but genetic factors, lifestyle choices, and environmental influences are believed to play a role. Approximately one in five people will develop dementia in their lifetime. Early diagnosis and intervention are crucial for managing the disease and improving quality of life for patients and their families.

The Zorginstituut’s decision serves as a stark reminder that while scientific progress is being made, a truly effective treatment for Alzheimer’s disease remains elusive. The focus must remain on supporting ongoing research, improving patient care, and providing comprehensive support for those affected by this devastating illness.

The next step in this process will be the formal response from the Minister of VWS, expected within the coming weeks. This decision will have significant implications for patients and families in the Netherlands, as well as for the broader landscape of Alzheimer’s treatment and research. We encourage readers to share their thoughts and experiences in the comments below.