23 January 2006

Anger over Alzheimer's drugs ruling

The revised guidance on drugs for the treatment of Alzheimer's disease has been greeted with anger by Alzheimer's charities.

Draft guidance published by the National Institute for Health and Clinical Excellence (NICE) recommended that donepezil, rivastigmine and galantamine should only be considered for patients with "moderate" symptoms of the disease.

A fourth drug, memantine, which is used for treatment in the later stages of Alzheimer's, will also not be funded for new patients, because NICE ruled that there was "insufficient evidence" of its clinical benefit.

NICE's previous guidance on the drugs provoked controversy last March, because it recommended that the NHS should fund none of the drugs because they were not cost-effective.

Andrew Dillon, NICE Chief Executive, said: "By going the extra mile and asking the drug companies to delve deeper into their clinical trial data, we have been able to identify the right way to use these medicines.

"People with Alzheimer's will now receive these drugs when they can help them most."

However, the Action on Alzheimer's Drugs alliance, which represents over thirty charitable and professional organisations, said that the guidance still placed "severe restrictions" on access to drugs. Neil Hunt, a representative for the alliance, said: "We are relived that NICE has withdrawn its plan to place a blanket ban on the only drug treatments for people with Alzheimer's disease. However, the new draft guidance that NICE has produced still raises serious ethical and practical concerns.

"It recommends that people be denied a drug treatment that may help them until they have declined sufficiently for that treatment to represent good value for money.

"People with dementia and their carers value the benefits that the drug treatments bring in the early stage of the disease. For what other condition would you wait until people decline so much that they can no longer look after themselves before giving them treatment?"

Dr David Wilkinson, a psychiatrist specialising in old age and member of the alliance, said that if the guidance was approved, professionals would be placed in the "impossible situation of withholding beneficial treatments from people with dementia because they are not ill enough". He said: "Drug treatments that work must be available to those who need them and clinicians should be able to use their professional judgement to decide when to prescribe them."

A consultation will take place on the guidance over the next three weeks. The final guidance is expected to be issued to the NHS in July.

(KMcA/SP)