By Lilian Anekwe
NICE has given the go ahead for patients with mild forms of Alzheimer’s disease to be prescribed dementia drugs, lifting previous controversial restrictions on the use of drugs in patients with less severe Alzheimer’s.
In its draft guidance, NICE confirmed that it is extending previous recommendations for the use of three drugs – donepezil, galantamine and rivastigmine – to allow patients with mild, as well as moderate Alzheimer’s disease, to receive drug treatment.
The guidance also recommended the use of memantine for severe disease and for some patients with moderate disease.
The recommendations represent a major reversal of the NICE position. It had previously ruled out the use of drugs in patients with mild forms of the disease and restricted memantine to clinical trials for patients with moderate to severe symptoms, triggering a stream of campaigns and High Court battles from lobbyists and pressure groups.
Sir Andrew Dillon, chief executive of NICE said the guidance reflected new evidence and new data on the cost-effectiveness of drug treatment and the costs of the disease to the NHS.
‘Since 2007 clinical trials have continued to show the positive effects of these drugs and, in the case of memantine, have reduced the uncertainty about its clinical effectiveness. In addition, we now have more information about the costs of living with and treating this very distressing disease, as it progresses through its mild, moderate and severe stages.’
GP experts said the move to widen the use of dementia drugs will provide a welcome alternative to prescribing antipsychotics.
Dr Ian Greaves, a GPSI in dementia in Gnosall, Staffordshire, said: ‘The best management option is still supportive care, and the guidance makes that clear. All any of these drugs can do is slowing the progression of the disease down, but they are not a cure.
‘Acetylcholinesterase-inhibiting drugs are good for early disease while memantine is good for patients with behavioural problems, and can be used as an alternative to antipsychotics. We’ve had a lot of stick for over-prescribing antipsychotics so it’s good at last to have an alternative option.’
The guidance recommends the drugs are initiated in secondary care and prescribed by GPs with a special interest in dementia under shared care arrangements. The final guidance is expected to be published in March.
Patient’s with mild Alzheimer’s disease can now receive drug treatment