Finally, after decades of frustration, dashed hopes and painstaking research, an effective treatment for Alzheimer’s disease appears to be on the horizon. In a randomised clinical trial involving 1,736 older people, donanemab, an antibody designed to remove amyloid plaques from the brain, was found to successfully slow down the progression of early Alzheimer’s disease by 35%.
This means that those who receive the drug could have a year more of independent living ahead of them, which will be wonderful news for dementia patients and their families. But, as ever, there are stings to this saga.
The research data shows that donanemab is at its most potent when it is administered to people with early-stage Alzheimer’s disease. However, the diagnosis and detection rates for dementia in the UK are woeful. It can take up to two years for someone to receive a diagnosis. By this time, their condition will have advanced to a stage where the new drug is ineffective.
Then there’s the clinical infrastructure required to administer the treatment – donanemab is delivered intravenously once every four weeks over a 72-week period. Treatment can only take place after the individual has undergone a lumbar puncture or positron emission tomograghy amyloid imaging (a PET scan) to determine if they are amyloid positive. Only 2% of people in England and Wales are diagnosed in this way.
Scientists believe the NHS will need to undergo a mini-transformation to safely deliver this treatment. This will involve setting up infusion clinics, investing in diagnostic tools to detect the neurodegenerative disorder and MRI scans to monitor the side effects of the drug, which are considerable.
Unfortunately, a decade or so of austerity has left the NHS in no state to fund expensive imaging equipment or to hire the specialist staff required to deliver this treatment. Sadly, despite the Herculean efforts of scientists to develop a promising treatment for this heartbreaking disease, it now looks as though once donanemab receives regulatory approval, it may only be available to people who can afford to pay for private healthcare.
Donanemab is not cheap. Early estimates indicate that a course of treatment will cost somewhere in the region of £25,000, putting this new drug firmly out of the reach of all but a small percentage of people. As a consequence, scientists believe further steps towards finding a cure for this disease may be squandered. This is because it is important for a diverse group of people to take all new drugs in order to prove that the treatments will have a similar effect for everyone living with a disease.
As scientists grapple with an uncomfortable unintended consequence of this breakthrough drug, the cash-strapped NHS will be left to piece together the lives of the tens of thousands of families each year who continue to be pushed to breaking point trying to cope with a relative living with the disease.
