Promising new Alzheimer’s treatments lecanemab and donanemab face NHS rejection despite being approved by UK regulators, leaving patients without access to the first drugs shown to slow disease progression.
At a Glance
- Breakthrough drugs lecanemab and donanemab, which slow Alzheimer’s progression by targeting amyloid plaques, have been approved by UK regulators but face NHS rejection
- NICE is likely to reject NHS coverage due to cost-effectiveness concerns, with donanemab’s cost estimated at 5-6 times above acceptable NHS resource use
- Implementation challenges include infrastructure limitations, diagnosis delays, and the need for specialized healthcare training
- Current NHS Alzheimer’s treatments only manage symptoms through medications like AChE inhibitors and therapies like Cognitive Stimulation Therapy
- Experts warn the NHS is “not ready” for new Alzheimer’s treatments, with concerns about regional disparities in access
The Promise and Reality of New Alzheimer’s Treatments
The UK finds itself at a crossroads in Alzheimer’s treatment as the first drugs shown to slow disease progression face significant hurdles to NHS implementation. Despite UK regulatory approval for lecanemab and donanemab, both treatments targeting amyloid plaques in the brain, NHS patients are unlikely to gain access due to cost and implementation challenges. Lecanemab has demonstrated a 27% slowing of Alzheimer’s progression over 18 months, while donanemab shows potential to delay cognitive decline by 4-7 months. These represent modest but significant advances in a field that has seen little progress for decades.
The National Institute for Health and Care Excellence (NICE), which determines NHS drug coverage, has signaled these treatments will likely be rejected based on cost-effectiveness assessments. Helen Knight of NICE stated that “Donanemab could slow down cognitive decline by 4-7 months, but this is just not enough benefit to justify the additional cost to the NHS. The cost-effectiveness estimate for donanemab is five to six times above what NICE normally considers an acceptable use of NHS resources.” This economic reality creates a significant barrier between promising scientific advances and patient access.
Current Treatment Landscape and Implementation Challenges
Currently, NHS treatment options for Alzheimer’s focus on symptom management rather than disease modification. Acetylcholinesterase inhibitors increase levels of acetylcholine in the brain to help nerve cells communicate, while memantine is prescribed for moderate to severe cases. Non-pharmacological approaches like Cognitive Stimulation Therapy (CST) provide group activities to improve memory and problem-solving skills. These treatments offer temporary symptom relief but do not address the underlying disease progression that the new medications target.
Beyond cost concerns, the NHS faces significant infrastructure and capacity challenges in implementing these new treatments. Research reveals systemic barriers including late diagnosis of Alzheimer’s disease, poor patient record-keeping, and inadequate research integration in routine care. Introducing new treatments would require substantial investments in diagnostic capabilities, particularly for brain imaging needed to identify suitable patients and monitor treatment effects. Experts have warned about potential regional disparities in access, with concerns about a “postcode lottery” for necessary brain scans.
Safety Concerns and Future Directions
Safety considerations present another layer of complexity in treatment adoption. Both lecanemab and donanemab carry risks of serious side effects, with studies showing that 37% of donanemab patients experienced brain swelling or bleeding compared to 15% on placebo. Lecanemab is administered as an intravenous infusion, requiring specialized healthcare settings and trained staff, further complicating implementation within existing NHS resources. The monitoring requirements for these side effects add to the already strained healthcare system’s burden.
While current treatments face rejection, clinical trials continue with promising candidates including semaglutide, remternetug, hydromethylthionine mesylate (HMTM), and blarcamesine. Advances in blood-based biomarkers may eventually transform Alzheimer’s identification and monitoring, potentially making future treatments more accessible and cost-effective. For healthcare systems to better accommodate these innovations, research suggests improvements needed in trial recruitment strategies, including more pragmatic entry criteria, flexible visit scheduling, and better integration of research into routine patient care.
