Positive Press for Alzheimer's Drug

Contributed by: Dennis Fortier, President, Medical Care Corporation

A few days ago, I wrote about some "negative press" for the Alzheimer's drug Namenda, that I felt was misleading.  Basically, it was a series of stories emphasizing that, when used in a way that is not approved, the drug provides little benefit to the patient's health.  What should have been legitimate news about bad prescribing habits, became an illegitimate story about poor drug efficacy.

Now, the press is covering the same drug in a new light.  Based on news from Reuters today, Germany's health care watchdog agency has reversed an earlier stance and now advocates that Namenda has clear health benefits.  They consider the drug to be a cost effective approach to treating moderate and late stage Alzheimer's disease.

The new position from German authorities was based on ongoing review of a growing data set that demonstrates the drug's beneficial effects.  This is reminiscent of the recent news from the UK where authorities changed their stance on the cost benefits of a group of Alzheimer's drugs, including Namenda, and began to cover the cost of their use.

There is no doubt that better treatments, be they drugs or other interventions, are needed in the Alzheimer's field.  But the long debate about efficacy of the current drugs is being clarified through the ongoing collection of evidence that early intervention and proper treatment are beneficial.

Alzheimer's Treatment May Be More Effective Than You Think

Contributed by: Dennis Fortier, President, Medical Care Corporation
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The message in this post may be one of the most important that the Brain Today blog regularly supports.  Alzheimer's treatment is more effective than the typical news story reports.

This is evident by the news from the UK today, where their governing health authority, the National Institute of Health and Clinical Excellence (NICE), extended coverage of approved drugs for Alzheimer's patients in earlier stages of the disease.  Authorities cited "better evidence" about treatment efficacy as the key motivator for the decision.

In general, the misconception about treatment effectiveness is based on three misleading frames of thought:

Drugs don't treat the disease, they only lessen the symptoms
Many well done studies support the claim that approved drugs offer no disease delaying effects.  The problem with this frame of thought is that all of the studies have been conducted on patients who are demented due to Alzheimer's.  Based on the long disease course, this means they are in a very advanced state of disease progression, and have already accumulated massive damage in the brain.  As such, it is not surprising that drugs cannot delay disease progression when treatment is initiated at such a late stage.  It stands to reason, and most experts agree, that the earlier stages of the disease are much more treatable.

The beneficial effects of drugs on symptoms last only a year or less
Again, there are many well done studies that support this notion.  However, the studies isolate "drug treatment" in order to measure its effects, whereas in the real world, Alzheimer's treatment involves more than a drug.  A robust treatment regimen includes proper diet, physical exercise, proper management of hypertension and diabetes, intellectual stimulation, social engagement, and an educated caregiver.  Many patients derive meaningful, long-term benefits from such an approach, especially if the intervention is begun at an early stage of the disease.  A drug alone may not be an effective treatment, but effective treatment does not consist of a drug alone.

There is no cure
This is absolutely true.  But the public has a tendency to interpret that statement to mean "there is no treatment".  For perspective, there is no cure for hypertension or for diabetes, but we commonly treat them, and the public generally acknowledges the benefits of such treatment.  For sure, the efficacy of our Alzheimer's treatments pale in comparison to the efficacy of our hypertension/diabetes treatments, but we need a healthy appreciation for the difference between treatment and cure for Alzheimer's disease.

I hope this high level decision by the health authority in the UK will foster a growing optimism and a more clear perspective on treatment efficacy for Alzheimer's disease.  I concur that we need better treatments than those available today, but we also need the public and the medical community to embrace a more constructive view of what can be done now.

Are Alzheimer's Drugs Better than Previously Thought?

Contributed by: Dennis Fortier, President, Medical Care Corporation
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A very big story about Alzheimer's treatment is unfolding in Europe. This story is big from a news coverage point of view and also from the perspective of real world impact. I am referring to the story about the National Institute for Health and Clinical Excellence (NICE) in the U.K. that has reviewed ongoing science and reversed their earlier stance on Alzheimer's drug efficacy.

Background
In 2006 and 2007, NICE recommended against National Health Services paying for cholinesterase inhibitors (the primary class of Alzheimer's drugs) for patients with mild to moderate Alzheimer's disease. They based this recommendation on a financial analysis suggesting that the economic benefits of treating AD with those drugs (Aricept, Exelon, and Razadyne) in its mild and moderate stages did not outweigh the costs of the treatment.

Naturally, that recommendation sparked lots of debate, including an argument that most experts considered very legitimate. The argument was that "average treatment effect" is merely a composite derived from some patients who responded well to treatment and others who did not. Since it was clear that treatment has meaningful benefits for some patients, and no one can predict which patients will respond, then everyone deserves the chance to find out.

New Position
Now, based on an ongoing review of emerging data from new studies, NICE is planning to revise that recommendation. This is great news for the patients afflicted with AD who have not yet progressed to the severe dementia stage. It is also important for the effect this move will have on the global conversation and the public perception of treatment efficacy.

Optimal Treatment
The one point I think needs to be added to this story is that, the drug class in question is only one part of the robust treatment approach we know to be most effective in delaying the progression of Alzheimer's disease. Optimal treatment includes poly-therapy (cholinesterase inhibitor plus Namenda), a balanced diet, physical exercise, and tight control of other conditions such as diabetes and hypertension.
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Limited Availability of AD Drugs in the UK

Contributed by: Dennis Fortier, President, Medical Care Corporation
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The National Institute for Health and Clinical Excellence (NICE) in the UK has ruled again that paying for cholinesterase inhibitors (drugs including Aricept, Exelon, and Razadyne) is not a cost-effective use of NHS funds. As such, these drugs are essentially unavailable to patients with mild Alzheimer's disease in the UK.

In 2005, NICE made the initial ruling that denied reimbursement for these drugs for mild and moderate stage Alzheimer's patients. After public outcry, the ruling was amended to allow treatment for moderate but not mild stage disease. With a rightly unsatisfied public, the manufacturers of these drugs pushed for a judicial review which has yielded this latest news of NICE standing firm on its past decision.

It is speculated that, with the judicial process complete, NICE will begin a new review of its policy incorporating latest clinical data that may lead to a more aggressive treatment policy going forward.