Unlock Editor’s Digest for free
FT editor Roula Khalaf selects her favourite stories in this weekly newsletter.
The author 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 UK’s Medicines and Healthcare products Regulatory Agency has been overshadowed by a disappointing preliminary decision by the National Institute for Health and Care Excellence not to make the treatment available to the NHS.
In the early 1990s, when my team first proposed that Alzheimer’s disease was triggered by the buildup of amyloid proteins in the brain, the idea was not universally accepted. The success of Lecanemab in trials underscores the importance of this theory, as it directly targets amyloid proteins and removes them from the brain.
Lecanemab is the first of a new generation of drugs that target the underlying process of Alzheimer’s disease, rather than just treating its symptoms. It has already been approved in countries such as the United States and Japan. It is a huge achievement, but it is only the beginning. Lecanemab has modest benefits (a slowing of decline by four to six months) combined with side effects that require careful monitoring and are expensive. However, we are now seeing a second generation of drugs targeting amyloid that appear even more effective, with fewer side effects.
There will never be a single magic solution for Alzheimer’s. In the case of cancer and HIV, success has been achieved with combination treatments that target different disease processes. The same is likely to be true for Alzheimer’s. In addition to clearing amyloid, we need treatments that can protect brain cells from damage and treatments that restore lost brain function. My hope is that combinations will be found that are tailored to the type of dementia a person has and the stage of the disease they are in.
That may not be too far-fetched an idea. For Alzheimer’s disease (the most common cause of dementia), there are more than 120 experimental treatments being rigorously tested in more than 160 clinical trials. Only 18 percent focus on amyloid, which shows how quickly the field is advancing. The question is not if we will have more effective treatments, but when.
Key to the advancement of these new therapies is the continued work of initiatives such as the UK Dementia Research Institute and Alzheimer’s Research UK’s Drug Discovery Alliance, which alone has collaborated with organisations from 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 that those of us in the scientific community, people living with dementia, their families and these organisations do will be for naught if healthcare systems cannot provide access to new treatments as they emerge. The lack of preparedness to implement 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 who are eligible receive this treatment (which, let’s be clear, has been deemed safe and effective enough to have been granted a licence by the MHRA). We hope that the forthcoming decision by the Scottish Medicines Consortium will reflect this and allow access to people living in Scotland.
We are on the cusp of a new era in Alzheimer’s care. 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 ensure that effective new treatments reach all those who could benefit from them.
If investment and collaboration continue, there will be a future in which this devastating disease will no longer be a death sentence, but a condition that can be managed and, eventually, cured.