Following the momentous news that Alzheimer’s drug, lecanemab has successfully completed a clinical trial, policy institute Curia announces the launch of a new Dementia Commission.
The first drug to slow the Alzheimer’s has been heralded as “momentous” by researchers. With a new era of Alzheimer’s therapies around the corner for patients with cognitive decline, regulators will now begin the process of approvals. Healthcare systems will now also need to think through appropriate care pathways to ensure drugs that slow cognitive decline is provided to patients in a timely fashion.
Sponsored by Roche and Eli Lilly, Curia will extend the work of their 2022 NHS Innovation and Life Sciences Commission and apply the recommendations to the neurodegenerative care pathways. It is important to stress that the Commission will not speak about specific medicines and only look at the treatment pathway. The Commission will be chaired by independent commissioners with an advisory board of patient and research charities.
Breakthrough in dementia research
Developed by Biogen in the US and Eisai in Japan and whilst not a miracle cure, the antibody therapy removes clumps of protein called beta amyloid that builds up in brain.
Presented at the Clinical Trials on Alzheimer’s Disease conference in San Francisco and published in the New England Journal of Medicine, the clinical trial showed the drug reducing the decline in patients’ overall mental skills by 27% over 18 months. Researchers have called this a “modest but significant result.”
The trial involved 1,795 volunteers with early-stage Alzheimer’s where they received infusions of lecanemab, given every fortnight.
Director of Research from Alzheimer’s Research UK, Dr Susan Kohlhaas said it was a “modest effect… but it gives us a little bit of a foothold” and the next generation of drugs would be better.
Professor Tara Spires-Jones, from the University of Edinburgh, said the results were “a big deal because we’ve had a 100% failure rate for a long time”.
Risks with adoption
While there has been widespread excitement at the results, there remain several significant hurdles before the drug becomes widely available to patients.
First, Lecanemab is expensive, estimated to be between £10,000 and £30,000 per patient a year. Given that researchers have only suggested that the drug has a modest effect, it is unclear whether patients would notice any benefit.
The other potential concern is that it is not clear when, and even whether, it will be approved by the UK’s Medicines and Healthcare products Regulatory Agency (MHRA) and the National Institute for Health and Care Excellence (NICE). This is a concern given the value for money criteria that regulators measure impact against.
Third, is the nascent patient pathways designed by the NHS in the UK. While many may think that NHS England could simply copy and paste pathways from other conditions, the pathways need to be thoroughly thought through. Given the potential benefit to some patients, and cost implications, it will be important for the NHS to set out transparently which patients will benefit and how that pathway will be managed.
10-Year Dementia Strategy
Earlier this year, former Health and Care Secretary Sajid Javid promised to publish a Ten Year Dementia Strategy at the Alzheimer’s Society conference. With a new Prime Minister, there is concern that the new Health and Care Secretary, Steve Barclay is not prioritising the issue as much as his predecessor.
At the NHS Providers’ annual conference in November, Barclay failed to mention dementia as a key priority in a speech setting out his key priorities.
With more than 850,000 people in the UK with some form of dementia, according to the Alzheimer’s Society, everyone would need testing to identify patients.
Chief Executive of Alzheimer’s Society charity, Kate Lee called for a 10-year government strategy on dementia to deal with what she called the “biggest health crisis we face in the UK”.
Curia’s Dementia Commission:
Curia’s Dementia Commission will uniquely bring national, regional and local leaders together to implement a plan to set out a plan to improve the life chances of all people living with dementia and other neurodegenerative conditions. A panel of Commissioners with a specialism in neurodegeneration will be convened to help the Curia research team produce solutions to improve implementation. Case studies on neurodegenerative conditions and good examples of best practice will feature at a series of inquiry sessions and in the final report.
Four roundtable inquiries will create a vision for what the environment needs to look like to support people with neurodegenerative conditions, namely dementia and be ready for future treatment pathways. The roundtables will produce recommendations for how outcomes can be improved. Stakeholders will include clinical leads, commissioners and regulators including NICE, NHS England and patient organisations. Each roundtable will have a remit to look at how pre-existing policy can be implemented, identifying where gaps exist in the policy landscape and setting a series of recommendations to explore the improvement in the system for patients with a neurodegenerative condition.
Curia will publish the findings at a Parliamentary launch alongside the reports from roundtables to ensure maximum engagement.
Find out more
To find out more about Curia’s Dementia Commission, please contact Policy and Research Analyst for Healthcare and Life Sciences, Harry Blacklock.
