23/01/06 Thousands of Scots Alzheimer's sufferers will be denied drugs
LOUISE GRAY
TENS of thousands of Scots who suffer from Alzheimer's disease will be denied breakthrough drugs because they fail arbitrary tests, according to a leading dementia charity.
At the moment the drugs donepezil (Aricept), rivastigmine (Exelon) and galantamine (Reminyl) are all available for mild to moderate Alzheimer's on the NHS.
But following reassessment, the National Institute for Clinical Excellence (NICE) has today recommended only patients with moderate Alzheimer's should receive the drugs.
A fourth drug, memantine (Ebixa), which campaigners want made available for patients with severe Alzheimer's for the first time, was not recommended at all.
Jim Jackson, chief executive of Alzheimer Scotland, said around 60 per cent of the 35,000 Alzheimer's patients in Scotland could be denied the drugs.
"There will be 20,000 people in Scotland in the future who will not be eligible for these treatments," he said.
"We are profoundly disappointed they [NICE] have not moved further to cover mild Alzheimer's, and that they have not made any positive recommendation for memantine."
The three drugs, which can delay the onset of Alzheimer's, are known as anticholineseterase inhibitors. They work by slowing down the loss of acetylcholine, one of the chemicals associated with memory and learning, in the brains of Alzheimer's victims.
NICE had originally considered banning the three drugs, which cost £2.50 a day per patient and £60 million a year.
But after uproar from relatives, the recommendation was reversed. The final guidance will be issued in Scotland later in the year, after approval by NHS Quality Improvement Scotland (QIS) is completed.
Mr Jackson welcomed the reversal, but was disappointed at the new restrictions.
"By prescribing these drugs to people with moderate Alzheimer's disease only, we risk losing momentum for early diagnosis, and some people who would have benefited from drug treatment will lose out," he said.
Assessment for patient suitability will be dependent on the Mini Mental State Examination (MMSE), and drugs prescribed if the patient scores between ten and 20 points.
Mr Jackson said MMSE scores do not provide accurate assessment of quality of life in people with Alzheimer's. Also, many patients who are not severe enough will be denied the treatment because they score too highly.
"It is particularly upsetting for families who have gone all the way through the process of diagnosis, then doctors say there is nothing we can do for you, wait until it gets worse and then come back."
Alzheimer Scotland will be campaigning for the drugs to be given to more patients after assessment by a psychiatrist. But Andrew Dillon, chief executive of NICE, said evidence from clinical trials ensured doctors were issued with the right advice.
He said: "People with Alzheimer's will now receive these drugs when they can help most. Patients and carers will be able to feel more confident about gaining benefit from them and the NHS will know it is using funds to best effect."
Dr Harpreet Kohli, NHS QIS medical advisor, promised to look at the recommendations.
He said: "We always consider possible differences in the application of NICE appraisals for Scotland and involve experts."
Memantine, which has failed recommendation by the Scottish Medicines Consortium, was also ruled out by NICE for treatment to alleviate the agitation and aggression suffered by people in the later stages of the disease. The drug costs £69 a month.
From (thescotsman.scotsman.com)