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Fiona fox's blog
Drugs will now be made available to patients that were previously not available on grounds of cost.
Prof Nick Fox, Professor of Neurology, UCL Institute of Neurology, said:
“It is excellent news that there will now be treatments available for patients who are mildly affected rather than having to wait until they are severe enough to qualify. This decision will be welcomed by patients and their families and also by their clinicians.
“These are not wonder drugs but they have proven, albeit modest, symptomatic value and we should be able to offer them to all patients who may benefit. At the same time we do still need to find therapies that will actually slow or prevent this devastating disease.”
Donald Singer, British Pharmacological Society and Professor of Clinical Pharmacology and Therapeutics, University of Warwick, said:
“The proposal by NICE to extend its guidance to include access for 3 drugs (donepezil, galantamine and rivastigimine) to patients with much milder disease than previously eligible is excellent news for patients with Alzheimer’s disease and their families. It is also very encouraging to have in the guidance a new treatment option (memantine) for patients with more severe disease.
“People with serious conditions such as Alzheimer’s may naturally express concern about how long this has taken. However it is essential that health policy makers have convincing evidence both for effectiveness and risk before making a medicine available to people who could benefit. Consider the recent public concern about regulation of the diabetes drug rosiglitazone, for which an unexpected increase in cardiovascular risk appears to have occurred after it became widely available.
“It will still be very important to remain vigilant for possible unexpected risks of the Alzheimer’s treatments, as these drugs will now be exposed to large numbers of people, who may also be medically more complex, and therefore more at risk of adverse effects, than in the clinical trials on which the NICE guidance has been based.”
Prof Carol Brayne, Professor of Public Health Medicine, University of Cambridge, said:
“NICE have a key role in determining whether the available evidence is sufficient to warrant large investments of public money for population benefit which includes individual patient treatment. It is very good news that this rigorous and independent process has drawn the conclusion that research is sufficiently robust to make these recommendations.
“Even so these treatments are only a small part of the story and much more research is needed to inform societal decisions about investment in all aspects of prevention, detection, cure and care.”
Dr James Warner, Consultant in Older Adults Psychiatry, St Charles Hospital and Honorary Reader in Psychiatry, Imperial College London, said:
“This is brilliant news!
“It has always seemed to me to be perverse (at least from a clinical if not economic perspective) to exclude people with early Alzheimer’s disease from receiving ACHIs. It would be terrible to give someone a diagnosis of Alzheimer’s disease and say “come back in two years and I will treat you” As a result I have treated many people with mild dementia (MMSE>20) and many of those have had significant benefit that they otherwise would have been denied. Many of my colleagues have done the same but have run the risk of censure by Trusts and Commissioners as a consequence.
“I am delighted that NICE have seen sense on this point.
“The remaining question is why these treatments are not approved for Vascular dementia? The evidence base for effectiveness is good.”
Prof Gordon Wilcock, Professor of Clinical Geratology, University of Oxford, said:
“Marvellous news. Common sense prevails.
“I am delighted that the three cholinesterase inhibitors will be available on the NHS again for mild dementia caused by Alzheimer’s disease, rather than only for those who could afford a private prescription.
“The availability of memantine, (Ebixa,) on the NHS for the first time offers a real choice for people with moderately severe dementia, and treatment for those with severe dementia. This decision brings us into line with many other countries in the western world.”