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Roula Khalaf, Editor of the FT, selects her favourite stories in this weekly newsletter.
The writer is vice-president of Alzheimer’s Research UK
One step forward, two steps back. A landmark moment — the approval of lecanemab, a treatment for early Alzheimer’s disease — by the Medicines and Healthcare products Regulatory Agency in the UK has been overshadowed by a disappointing preliminary decision by the National Institute for Health and Care Excellence not to make this treatment available on the NHS.
Back in the early 1990s, when my team first proposed that Alzheimer’s disease was triggered by the build-up of amyloid proteins in the brain, the idea was far from universally accepted. Lecanemab’s success in trials underscores the importance of this theory, as it directly targets amyloid, removing it from the brain.
Lecanemab is the first of a new generation of drugs that target the underlying Alzheimer’s disease process, rather than merely addressing its symptoms. It has already been approved in countries such as the US and Japan. This is a tremendous achievement, but it’s only the beginning. Lecanemab has modest benefits — a slowing of decline by between four and six months — combined with side effects that require careful monitoring and high costs. However, we’re now seeing a second generation of amyloid-targeting drugs that seem even more effective, with fewer side effects.
There will never be a single magic bullet for Alzheimer’s. In cancer and HIV, success has come from combination treatments that target different disease processes. The same is likely to be true for Alzheimer’s. Beyond removing amyloid, we need treatments that can protect brain cells from damage, and others to restore lost brain function. My hope is of combinations tailored to the type of dementia a person has, and the stage of disease they are at.
This may not be too far off. For Alzheimer’s — the most common cause of dementia — there are over 120 experimental treatments being rigorously tested in more than 160 clinical trials. Only 18 per cent target amyloid, showing just how quickly the field is moving. It’s not a question of whether we will have more effective treatments, but when.
Central to advancing these new therapies is the ongoing work of initiatives like the UK Dementia Research Institute and Alzheimer’s Research UK’s Drug Discovery Alliance, which alone has collaborated with organisations in 13 different countries. These global partnerships are crucial to ensuring that promising scientific discoveries can be translated into effective treatments, as quickly as possible.
However, the work done by those of us in the scientific community, the people living with dementia, their families and these organisations will amount to nothing if healthcare systems can’t provide access to new treatments as they emerge. The lack of readiness to roll out new treatments in the UK has been evident for some time.
The NHS, Nice, Biogen and Eisai, the pharmaceutical companies behind lecanemab, urgently need to work together. They must find solutions to ensure that people don’t miss out if they’re eligible for this treatment — which, let’s be clear, has been deemed sufficiently safe and effective to be granted an MHRA licence. We hope the upcoming decision from the Scottish Medicines Consortium will reflect this and allow those living in Scotland access.
We are on the cusp of a new era in Alzheimer’s treatment. But to get there, governments, academic institutions, charities, pharmaceutical companies and society as a whole must continue to invest in research, support global drug discovery initiatives and make sure effective new treatments reach everyone who could benefit.
If investment and collaboration continue, there is a future where this devastating disease is no longer a death sentence, but a condition that can be managed, and eventually, cured.
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