Alzheimer's Drugs: UK Access Denied Despite Promise

In August 2024, the UK approved lecanemab for Alzheimer's treatment, a decision that dashed the hopes of many patients when the National Institute of Health and Care Excellence (NICE) refused to recommend it for NHS use. NICE cited that the drug's benefit of slowing disease progression by four to six months was too modest for its estimated £20,000 annual cost per patient, plus an additional £19,000 for monitoring.

Similar criteria led to donanemab's rejection in October 2024. Consequently, a limited number of UK patients currently access these drugs through private payment or clinical trials. Some patients are traveling from abroad for private prescriptions. Charities expressed disappointment, warning that this ruling makes the drugs inaccessible for most.

While NICE is reviewing aspects of its assessments, including the impact on unpaid carers, an overturn of the overall ruling is unlikely. The drugs' cost is considered five to six times higher than NICE's normal recommendation threshold. For approval, either the proven benefit must significantly increase or the price must decrease.

However, the future holds promise with new trials exploring drug combinations and a second generation of anti-Alzheimer's drugs in development. Remternetug, a follow-up to donanemab, is in a phase three trial and may offer lower administration costs. A major Cochrane review assessing anti-amyloid drugs is also expected soon, which could influence future recommendations.