A National Institute of Clinical Excellence committee came together yesterday to discuss proposals for curbing the use of certain drugs to treat Alzheimer’s disease under the UK’s National Health Service.

Draft proposals drawn up by NICE in March this year claim that the use of anti-cholinesterase drugs, which are not used to treat the disease itself but help to alleviate some of its symptoms, is not cost-effective as the medicines do not benefit all patients. This has cast doubt over the future of four drugs in the UK – Pfizer and Eisai’s Aricept, Johnson & Johnson and Shire’s Reminyl, Novartis’ Exelon and Lundbeck’s Ebixa, and effectively overturns a decision in 2001 endorsing the use of these agents.

NICE asked companies to re-assess clinical data to see if those patients most likely to respond to treatment can be identified, before it publishes its final review. Although re-analysis of data by Eisai and Pfizer in respect of Aricept failed to provide an indicator of which patients are most likely to benefit, it showed that between 30% and 68% were likely to respond to treatment, suggesting that these drugs are more cost effective than was previously thought.

Dr Paul Hooper, managing director of Eisai, said: “NICE had been looking for evidence that these medicines work better in certain groups of patients. The evidence presented shows they can help a broad range of patients and their cost-effectiveness may have been under-estimated.” He concluded that, “Since it isn’t possible to tell at the start of treatment which patients will do well and which patients will obtain less benefit, existing NICE guidance that all diagnosed patients be offered a chance of the medication in the first instance seems a sensible course of action.”

The potential removal of these drugs from use in the NHS has caused uproar from all sides of the industry. Psychiatrists recently issued a damning indictment of the proposal, with 96% of those surveyed not supporting the decision. A questionnaire that went out to 134 members of the Royal College of Psychiatrists Faculty of Old Age also revealed that 67% of psychiatrists would continue prescribing the drugs anyway, and 87% believed that their dementia service would suffer as a result of NICE withdrawing approval.

Although any decision (expected in January) will be UK-centric, if the ‘thumbs down’ is issued the resulting shockwaves could be felt by other global health organisations, which may think twice before advocating the use of these ‘costly’ therapies.