November 27, 2022

Patients could receive a breakthrough Alzheimer’s drug within a year, experts said, but only a small proportion of patients will benefit unless more is done to boost dementia services in the NHS.

Experts have estimated that unless there are drastic changes in UK dementia clinics, only 5% of patients eligible for the drug will be able to access it – and most of these will be private cases.

In September, scientists hailed a “historic moment” in Alzheimer’s research as a new drug was found to slow memory decline among patients with the early-stage disease.

Lecanemab, which is designed to target and remove amyloid — one of the proteins that builds up in the brains of people with Alzheimer’s — has been shown to slow the decline of patients’ memory and thinking.

The scientists found that after 18 months, the drug slowed the progression of the disease by 27% compared to patients taking a placebo.

Experts said UK officials have a long way to go to prepare for the drug’s delivery, provided it gets regulatory approval.

The drug, created by Tokyo-based pharmaceutical company Eisai and US biotech firm Biogen, was created to treat mild cognitive impairment in patients with amyloid in the brain.

There are two ways to tell if there is amyloid on the brain – a brain scan or a biomarker test which is currently done by lumbar puncture.

While a blood test is on the horizon, dementia services have to rely on these tests which are expensive and can have long waiting lists.

While private patients and those living near large dementia services can access these diagnostic tests, the vast majority of the public cannot, experts said.

Experts have warned that unless there are major changes in diagnostic services, people could become ineligible for Lecanemab treatment while on the diagnostic waiting list, as it can only be given to patients with mild disease – if their disease progress to a moderate stage while waiting. list, they will no longer be eligible for treatment.

More details about the Lecanemab study will be presented at the Clinical Trials On Alzheimer’s Congress in the US next week.

British experts have expressed enthusiasm for the results of recent amyloid drug trials and said they are optimistic “that we are seeing the beginning of Alzheimer’s therapies”.

But they warned that using Lecanemab in the UK would be “hard work”.

Speaking at a pre-conference briefing, Dr Susan Kohlhaas, director of research at Alzheimer’s Research UK, said: “The Lecanemab results bring a renewed sense of urgency to really improve the way we diagnose diseases like Alzheimer’s.”

Dr Liz Coulthard, associate professor of dementia neurology at the University of Bristol and North Bristol NHS Trust, added: “Over the years, as a profession, we have not used the biochemical definition of Alzheimer’s because we have not been able to test for until after people died.

“But now we have biomarker tests that have entered the clinical realm in the last five years or so that we can accurately diagnose people with Alzheimer’s disease.

“So if you’re working in a clinic where we don’t have biomarkers, the diagnostic accuracy for Alzheimer’s is about 70 percent — we can’t diagnose Alzheimer’s properly without doing biochemical tests.

“It wasn’t a priority because there were no molecular treatments, but now that there are, we need to start doing biochemical tests on everyone.”

She added that the “vast majority of people” do not receive a biomarker diagnosis and that there is “a huge gap between current service delivery and what we need to do to deliver disease-modifying therapies”.

Dr Mani Santhana Krishnan, director of the Faculty of Aging at the Royal College of Psychiatrists, added: “We need to prepare. It’s about getting our current memory services staffed robustly and technically advanced.”

But Professor John Hardy, chair of molecular biology of neurological diseases at the UCL Institute of Neurology, said there was precedent for the NHS to adapt quickly to new therapies – citing the launch of a treatment for multiple sclerosis.

Professor Hardy estimated that patients could receive treatment in the UK as early as next year.

“Of course it depends on the regulators, but I think we’ll see the first people towards the end of next year,” he said.

Asked what proportion of patients would benefit, Dr Coulthard said: “I would guess 5% – it would be given in the private sector because you could access the biomarker and you could access the biomarker tests (in the private sector).

“Then there are a few clinics in big cities now doing biomarker tests.

“It will be a small fraction of those who might be eligible, unless something changes.

“Or what’s going to happen is we’re going to have massive wait times, but the problem is people are going to wait longer… I think it’s not going to be licensed in moderate disease.

“So people will be on a waiting list and by the time they come to see us, they will be too advanced in the disease, which would be terrible.”

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