Using data on eligible patients from both Trusts and scaling up, the team estimate that a maximum of 30,000 people using dementia services around the country would be suitable for these potential treatments and that NHS providers could provide them on a small scale with the right investment, if approved.
This partnership study was supported by the National Institute for Health and Care Research (NIHR) Cambridge and Maudsley Biomedical Research Centres. Their paper has been shared with research and clinical communities in The British Journal of Psychiatry First View while the drugs are being reviewed for regulatory approval in the UK.
Lead author and CPFT Academic Clinical Fellow Dr Axel Laurell (centre) said: “‘Last year the first drugs which can slow down the progression of Alzheimer’s disease by targeting brain amyloid were identified as lecanemab and donanemab. This year they are being considered for approval to use in the UK. We wanted to answer a crucial question to help the NHS plan and prepare, by predicting the largest number of people that might receive these drugs if approved based on eligibility criteria from the clinical trials.”
The study team used anonymised research patient databases from Cambridgeshire and Peterborough and South London and Maudsley NHS Foundation Trusts and examined the records of 82,386 people referred to their services. Applying the eligibility criteria to receive these new types of drugs (monoclonal antibodies) for Alzheimer’s, such as diagnosis, stage of disease, other health conditions, brain imaging data and cognitive test results, they predict that 906 people every year could receive these treatments in their services. This model scales up to indicate around 30,000 people using dementia services nationally might use them.
Dr Ben Underwood (left), Assistant Professor in Applied and Translational Old Age Psychiatry at the University of Cambridge, Honorary Consultant Psychiatrist and Research and Development Director at CPFT led the study and said: “Our work, based on real NHS data, suggests that some of the drugs currently being appraised would only be appropriate for a minority of the people we see in clinic. This gives some idea of the potential scale of the challenge of delivering these new treatments in the NHS if they were approved for use. It is important that we continue to research alternatives that can benefit the majority of people living with Alzheimer’s disease. At CPFT, we work to test and bring the latest proven treatments to our patients as a research active Trust, when their safety and clinical efficacy has been assessed and approved for the NHS.”
Dr Ash Venkataraman (right), NIHR Academic Clinical Lecturer at the Institute of Psychiatry, Psychology and Neuroscience (IoPPN) King’s College London, Speciality Registrar in Old Age Psychiatry at South London and Maudsley NHS Foundation Trust and joint lead author said: “There is understandably a lot of anticipation around the potential of these new Alzheimer’s drugs, but they are both expensive and resource intensive as they require regular infusions and brain scans to check suitability and monitor side effects. As such, it is important to have an accurate estimate of how many people may be suitable for these medications to inform service provision. Our study is the first to do this at a detailed level using diverse patient data across two NHS Trusts.”
The NHS is a world leader in rolling out innovative treatments, including personalised cancer and life-saving gene therapies, and has established a dedicated programme team to prepare the NHS for the potential arrival of new Alzheimer’s treatments. They must first be approved by the Medicines and Healthcare products Regulatory Agency (MHRA) and meet National Institute for Health and Care Excellence (NICE) standards for patient safety, clinical and cost effectiveness.
NIHR’s BRCs are collaborations between world-leading universities and NHS organisations that bring together academics and clinicians to translate lab-based scientific breakthroughs into potential new treatments, diagnostics and medical technologies.
