A new drug that slows the progression of Alzheimer's disease needs to be given to UK patients in order to be effective.
The drug lecanemab reduced cognitive decline in patients with early-stage Alzheimer's in a hard-won breakthrough hailed as a historic moment for the field.
The drug is the first to show that it can change the trajectory of the disease. The drug slowed cognitive decline by 27% over 18 months, but doctors think it has the potential to give patients months more independence.
The US Food and Drug Administration is expected to approve lecanemab in January. Doctors say that patients are unlikely to receive the drug before the end of the decade.
Jonathan Schott is a professor at the Queen Square Institute of Neurology and the chief medical officer at Alzheimer's Research UK.
While some specialist centres have the capabilities required, the wider NHS simply does not have the infrastructure and staff to diagnose potentially eligible patients, nor to deliver the drug, which is given by injection every two weeks.
The view is shared by other senior doctors. Liz Coulthard is an assistant professor in dementia neurology at the University of Bristol. There needs to be a huge change in workforce service delivery.
A therapy called lecanemab targets clumps ofamyloid in the brain. Eliminating amyloid from the brain may prevent other pathological processes from taking hold.
Patients with mild cognitive impairment due to Alzheimer's typically have about six years of independent living before they need help. If the benefits of lecanemab are maintained over the course of six years, a patient might have 19 more months of independence.
She said that they don't see patients at the cognitive impairment stage. We don't have anything to offer. There isn't a pathway for mild cognitive impairment in Bristol. You are discharged if you are diagnosed with it.
Most dementia patients in the UK are cared for in memory clinics which do not have access to Alzheimer's tests. While blood tests for Alzheimer's are on the horizon, the disease is currently confirmed by a procedure called a lumbar puncture, which looks for amyloid in spinal fluid, or a Positron Emission Tomography Scan. Only 2% of patients eligible for lecanemab would have access to the drug, according to Alzheimer's Research UK.
We will need to have new services, either within psychiatry or neurology, that can deliver the large number of new diagnostic tests that we will need to do.
Alzheimer's is the leading cause of death in the UK. The majority of cases are related to Alzheimer's. The condition causes the destruction of brain cells, which leads to problems with decision-making, eating and movement.
Before Lecanemab could be given to the National Health Service, it would have to be approved by two agencies. It could take another year for the Nice review to be approved.
Masud Husain is a professor of neuroscience and neurology at the University of Oxford.
Hospitals need specialist staff and equipment to provide regular drug injections and scans to check for brain swelling, which can be caused by drug use. The hope is that the drug can be used in bursts, with patients taking it until their amyloid levels fall, then being monitored to make sure it doesn't go back up.
The head of the UK Dementia Research Institute at Imperial College London said he didn't think the UK would be a rapid adopter of lecanemab. It would give health officials time to assess how effective the drug was in real-world settings and prepare the National Health Service to deliver it.
"We need to improve dementia diagnosis in the UK to ensure the right people are getting these drugs when they are most effective." The aim is to make sure everyone gets a quick and accurate diagnosis.
If and when lecanemab becomes available in the UK, we think it will benefit at least 106,000 people. One in six people wait over a year to see a specialist after being referred, and one in 10 wait over six months for a brain Scan.
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