Thursday, August 22, 2024

The first drug that can slow the progression of Alzheimer’s disease is considered too expensive for the NHS.

The first drug to slow the progression of early-stage Alzheimer’s, lecanemab, will not be available on the NHS in England. The National Institute for Health and Care Excellence (NICE) stated that the benefits of the drug "are too small to justify the costs." Although lecanemab has been licensed for use in Great Britain by the Medicines and Healthcare products Regulatory Agency (MHRA) and can be prescribed privately, NICE's draft guidance points out that the treatment's high costs, which include intensive monitoring for side effects and biweekly hospital visits, outweigh the benefits.

The first drug that can slow the progression of Alzheimer’s disease is considered too expensive for the NHS.
Pexels.com/Anna Shvets

In clinical trials, lecanemab slowed cognitive decline by about 25% over 18 months in patients in the early stages of Alzheimer’s. However, NICE noted that the drug provides only four to six months of slowing in the rate of progression from mild to moderate Alzheimer’s, which does not offer enough benefit to justify the cost to the NHS.

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Alzheimer's Research UK described the situation as "bittersweet," with head of policy David Thomas calling NICE's decision not to approve the drug for the NHS "deeply disappointing." Dr. Samantha Roberts, chief executive of NICE, emphasized that the body thoroughly evaluated the evidence, including the impact on carers, but must ensure treatments provide good value for taxpayers. A final decision by NICE is expected later in the year after a public consultation.

Approximately 70,000 adults in England would have been eligible for lecanemab. Wales and Northern Ireland often follow medical guidance in England, while Scotland's drug assessment body has not yet decided on the drug's value. NHS England is also reviewing 27 other Alzheimer's drugs currently in advanced trials that may be approved in the future.

Lecanemab works by clearing amyloid, a protein that accumulates in the brains of Alzheimer’s patients, and is administered via intravenous infusion every two weeks. Although hailed as a breakthrough because it targets the disease's underlying mechanism, there are concerns about potential side effects like small brain bleeds and temporary swelling, which were observed in trials.

No price has been announced for the UK, but in the US, the drug costs about £20,000 per patient per year. Fiona Carragher of the Alzheimer’s Society expressed concern that NICE's decision would create uncertainty and confusion for the nearly one million people living with dementia. The MHRA has approved the drug with restrictions, excluding patients who have two copies of the ApoE4 gene or are on blood thinners due to the risk of side effects.

What is dementia, and is it the same as Alzheimer's?

Dementia is a set of symptoms that can occur due to various brain diseases. Memory loss, particularly difficulties in recalling recent events, is the most common symptom. Other symptoms may include changes in behavior, mood, and personality, getting lost in familiar places, or having trouble finding the right word during conversations. In severe cases, individuals may not realize they need to eat or drink. Alzheimer's disease is the most prevalent cause of dementia. Other conditions that can lead to dementia include vascular dementia, dementia with Lewy bodies, fronto-temporal dementia, Parkinson's disease dementia, amyotrophic lateral sclerosis, and a recently identified condition called Late.

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What are the early signs of Alzheimer's?

The initial signs of Alzheimer's often involve memory lapses. This might include forgetting recent discussions, misplacing items, not remembering names, or repeatedly asking the same question. There may also be mood changes, such as increased anxiety or confusion. More information on common symptoms can be found on the NHS website.

Do many younger people get Alzheimer's?

Alzheimer's mainly affects older adults, with one in six people over the age of 80 developing the condition. Early-onset Alzheimer's, which occurs in people under 65, is relatively rare, accounting for about 5% of all cases. Even fewer people develop it in their 30s and 40s. The only known risk factor for early-onset Alzheimer's is a family history of the disease. Currently, there is no known way to prevent it.

Can I prevent myself from getting dementia?

There is no proven method to prevent dementia. However, research suggests that lifestyle changes could potentially prevent about one-third of cases. These changes include:

  • Addressing hearing loss in mid-life
  • Spending more time in education
  • Quitting smoking
  • Seeking early treatment for depression
  • Staying physically active
  • Avoiding social isolation
  • Managing high blood pressure
  • Maintaining a healthy weight
  • Preventing type 2 diabetes

It's not entirely clear why these factors might help protect the brain. They might either slow the progression of dementia in the brain or prepare the brain to cope better, delaying the onset of symptoms.

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