UK needs Covid-like boost for dementia drugs, says former head of vaccine taskforce
Efforts similar to those used for Covid-19 are 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 taskforce.
Kate Bingham calls for the immediate recruitment of large numbers of patients to ensure the UK plays a leading role in testing and marketing medicines, as it did with Covid vaccines.
There are now two drugs that can slow cognitive decline in early-stage Alzheimer’s, but it is unclear whether either is effective enough to be made widely available on the NHS. So there is a race to achieve this goal.
“We need to have tens of thousands of patients who have given their consent and are available to do clinical trials,” Bingham said. “If you have 50,000 patients who are at high risk for Alzheimer’s pre-consented, we can make that an easy shortcut for companies, and that’s exactly what we’ve done with vaccines. The government needs to work with industry instead of thinking they’re out to get your pocketbook.”
Experts have expressed frustration that, almost two years after a groundbreaking study, the first Alzheimer’s drugs shown to slow cognitive decline have still not been approved in the UK.
Bingham, managing partner at SV Health Investors and responsible for launching the Dementia Discovery Fund, said trials of drugs and diagnostic tools should be a priority for the new Labour government given the devastating impact on health and healthcare costs.
“We live in an aging society, where medicines keep people alive longer in good health,” she said. “Cancer is no longer a death sentence. You can treat cancer and have a good quality of life for years. With dementia, we don’t do that. You have to pay for 10 years plus of patient care, essentially. The cost to the families or the state is very high. I think it’s 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 have been approved to treat early Alzheimer’s in the US. The drugs work by reducing amyloid levels in the brain.
Sir Prof John Hardy of University College London (UCL), who first identified the role of misfolded amyloid in Alzheimer’s 30 years ago, said: “We now finally have something that has started here in the UK, it would be great to see it actually help patients. There is frustration, yes.”
Hardy, vice-chairman of Alzheimer’s Research UK, said patients were already travelling abroad to receive the drugs, which are administered through an IV and require patients to be monitored with MRI scans. “I’ve just had two patients call me and they’re flying privately to New York to have the treatment,” he said. “That’s not a good outcome.”
However, others warned that the MHRA and the National Institute for Health and Care Excellence (Nice), which judges cost-effectiveness, would be under undue political pressure to rush the approval of new drugs because they can have complex risk-benefit profiles.
The cognition of Alzheimer’s patients given lecanemab declined by 27% less than that of patients given a placebo after 18 months, an improvement that some say is not clinically meaningful for an individual patient. This must be weighed against side effects such as accelerated brain shrinkage, with those taking the drug experiencing the equivalent of an extra teaspoon of brain matter for 18 months.
Rob Howard, 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 costs of providing them and ensuring patient safety will be high. We have been told that there will be no new money for the NHS to pay for these drugs and so we will have to cut other services to people with dementia if we want to provide them.”
He added: “No one has explained the worrying accelerated loss of brain volume seen with these drugs. Generally, loss of brain volume is considered a bad thing in people with dementia and I worry about the potential impact of this in the medium to long term.”
The case for the drugs could become clearer if patients show improved outcomes after the first 18 months, according to research results expected to be released during the study. Alzheimer’s Association Conference later this month.