Rivastigmine Alzheimer’s drug Hundreds of thousands more patients in the early stages of Alzheimer’s disease could get drugs under proposed changes to guidelines for England and Wales.
The National Institute for Health and Clinical Excellence says evidence backs the use of drugs for “mild” symptoms.
The draft guidance will reverse restrictions that stopped NHS doctors prescribing donepezil, galantamine and rivastigmine.
Campaigners said the decision represented a “momentous day”.
As many as 465,000 people in the UK have Alzheimer’s disease, and this is expected to rise as the population ages.
The availability of drugs for the condition on the NHS has been source of controversy for almost a decade.
While there has always been evidence they diminished the symptoms and boosted quality of life for some, it has not always been clear exactly how much improvement they could deliver, to which groups of patients, and for how long.
In 2005, drugs watchdog The National Institute for Health and Clinical Excellence (NICE) ruled that no-one should get the drugs on the NHS, then conceded a year later that patients with “moderate” disease should receive them, while still ruling out “mild” patients.
The secret formula used by NICE to calculate how much “value for money” the drugs offer to the NHS was then the subject of a court action by the Alzheimer’s Society and pharmaceutical companies.
After the case went all the way to the House of Lords, NICE was forced to first disclose the formula, then amend it after admitting “technical inaccuracies”, although it said this did not change the outcome.
That new review now proposes giving the drugs to patients with mild symptoms – which covers people in the early stages of the disease, perhaps suffering memory loss and confusion, but not yet dependent on carers for day-to-day activities.
It has also suggested a fourth drug, Ebixa, be made available for the first time to patients with more advanced disease.
The guidance is subject to appeal.
Chief Executive of NICE, Sir Andrew Dillon, said: “Clinical trials have continued to show the positive effect of these drugs.
“Our increased confidence in the benefits and costs associated with the use of the three drugs for treating mild and moderate stages of the disease has enabled us to make positive recommendation for their use in mild disease.
NICE’s equivalent in Scotland has indicated that it may follow the English decision.
“For the price of a cup of coffee they can mean the difference between recognising your loved ones and playing with your grandchildren”
Ruth Sutherland, Alzheimer’s Society
Ruth Sutherland, the interim chief executive of the Alzheimer’s Society, said that it was “a momentous day”, with approximately half of the 62,000 people who develop the disease every year likely to benefit from the drugs.
She said that the drugs, which cost approximately £2.80 per person per day, were not a “miracle cure”, but made important differences to people’s lives.
She said: “For the price of a cup of coffee they can mean the difference between recognising your loved ones and playing with your grandchildren.
“It is critical that this draft decision becomes a reality and that all people with Alzheimer’s are given the opportunity to benefit.”
The society’s Director of Research, Professor Clive Ballard, said: “If this guidance is issued, doctors will no longer have to watch people deteriorate without being able to treat them.”
Professor Roy Jones, from the Research Institute for the Care of Older People in Bath, described the decision as “an important milestone”.
He said: “Early diagnosis and access to medication is critical to help reduce both the short and long-term impact of this devastating condition on patients, families and carers.”
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