A Covid-style effort is needed to ensure NHS patients are first in line for a new wave of dementia drugs, according to the former head of the UK’s vaccine task force.
Kate Bingham is calling for the immediate recruitment of large numbers of patients to ensure that, as with Covid vaccines, the UK is a leading player in testing and launching medicines.
While two drugs are now shown to slow cognitive decline in early Alzheimer’s, it remains unclear whether either is effective enough to be made widely available on the NHS, meaning a race is on to achieve this goal.
“We need to have tens of thousands of patients consented and available to go into clinical trials,” Bingham said. “If you have 50,000 patients at high risk of pre-existing Alzheimer’s disease, we can make it an easy shortcut for companies, which is exactly what we’ve done with vaccines. The government needs to embrace working with industry to work rather than thinking they are out to cut your wallet.”
Experts expressed frustration that, almost two years after a breakthrough trialthe first Alzheimer’s drug shown to slow the rate of cognitive decline has yet to be approved in the UK.
Bingham, who is a managing partner at SV Health Investors and spearheaded the launch of the Dementia Discovery Fund, said drug testing and diagnostic tools should be a priority for the new Labor government, given the devastating health consequences and cost of care.
“We are in an aging society, where medicine keeps people alive for longer in good health,” she said. “Cancer is no longer a death sentence. You can manage cancer and have a good quality of life for many years. For dementia we do not. You basically have to pay for 10 years plus patient [care]. The cost to the families or state is very expensive. I think it is an economic imperative to invest in this whole area.”
The Medicines and Healthcare Products Regulatory Agency (MHRA) is considering applications for Eisai and Biogen’s drug lecanemab and Eli Lilly’s donanemab, both of which are approved for the treatment of early Alzheimer’s disease in the US. The drugs work by reducing amyloid levels in the brain.
Sir Prof John Hardy, from University College London (UCL), who was the first to identify the role of misfolded amyloid in Alzheimer’s disease 30 years ago, said: “We have now finally got something that started here in the UK , it would be nice to see that it actually helps patients. There is frustration, yes.”
Hardy, who is vice-chairman of Alzheimer’s Research UK, said patients were already traveling abroad to access the drugs, which are given by infusion and require patients to be monitored through MRI scans. “I just had two patients call me who fly privately to New York to get the treatment,” he said. “It’s not a good outcome.”
However, others have warned that the MHRA and the National Institute for Health and Care Excellence (Nice), which regulates cost-effectiveness, are coming under undue political pressure to rush through the approval of new drugs, which can have complex risk-benefit profiles .
The cognition of Alzheimer’s patients receiving lecanemab declined 27% less after 18 months than those on a placebo treatment, an improvement that some say is not clinically meaningful for an individual patient. This must be weighed against side effects that include accelerated brain shrinkage, with those taking the drug experiencing the equivalent of an extra teaspoon of brain matter over 18 months.
Rob Howard, a professor of geriatric psychiatry at UCL, said: “My own view is that these drugs cannot possibly be cost-effective for the NHS – the benefits of treatment are so small and the cost of giving them and insuring patients safety will be high. We have been told that there will be no new money for the NHS to pay for these drugs and therefore we will have to cut other services for people with dementia if we are to provide them.”
He added: “No one has explained the alarmingly accelerated brain volume loss seen with these drugs. In general, brain volume loss is seen as a bad thing in people with dementia and I am concerned about the potential medium to long-term impact of this.” “
The case for the drugs may become clearer if patients are found to have maintained a better course after the first 18 months in trial results expected to be revealed at the. Alzheimer’s Association conference later this month.
