Healthcare services may need to change to ensure that all patients have equitable access to new drugs with the potential to change the course of Alzheimer’s disease, according to new research from WIPH in collaboration with University College London (UCL) partners. The modifying anti-amyloid therapies are expected to be approved imminently in the UK.
Of the 944,000 people living with dementia in the UK, 60-80% have Alzheimer’s disease, but the currently available drugs for Alzheimer’s only treat symptoms. Recent clinical trials show that new therapies, which use monoclocal antibodies to remove amyloid plaques that form on the brain, may slow disease progression. Two of these disease-modifying therapies (DMTs) have been granted Breakthrough Therapy designation in the UK, and are likely to become available to patients by mid-2024 (pending regulatory approval).
Dementia care in the UK is mostly centred around psychiatry-led memory clinics in the community, but authors of the new study say it is extremely unlikely that DMTs will be administered in these settings. Delivery of the new treatments will require key changes to existing dementia services, from determining eligibility to delivery of the treatment itself, including follow-up. It will require additional staff and training across imaging, diagnostics and pathology, and other clinical services, as well as access to laboratories that can carry out biomarker testing to confirm whether a patient is eligible for the treatment.
The potential roll-out of DMTs presents major challenges for services and has real potential to amplify existing inequities in service access. To anticipate and mitigate these challenges, researchers from the WIPH Centre for Preventive Neurology, the Dementia Research Centre at UCL, and UCL Partners conducted a study to estimate how many patients are likely to be eligible for DMTs.
The study compared clinical case notes from over 1000 people attending either community memory clinics or specialist cognitive services in England. Results show that 32% of those attending memory services and 14% of people attending specialist cognitive services would be likely to be referred for consideration for the new DMTs. Researchers found that amyloid biomarker tests were available for people attending specialist cognitive services in the form of PET scans and spinal fluid tests, but fewer than 1% of people attending community memory clinics had undergone biomarker tests.
While a sizeable proportion of patients attending memory clinics may be referred for therapy for Alzheimer’s disease, only a minority are likely to be suitable, once they have undergone biomarker testing. The researchers highlight an immediate need for biomarker testing to ensure that the right patients can be identified for these treatments.
First author, WIPH Professor Ruth Dobson, said: ‘The development of disease modifying therapies for dementia has the potential to drive significant service changes. We have seen the impact of this in MS and stroke. It is crucial to understand and plan such changes proactively in order to ensure best care for all people living with dementia, regardless of initial treatment availability and eligibility.’
This study was produced by researchers from a network of universities who form the Academic Health Science Centre for UCL Partners and in collaboration with a network of clinicians in memory clinics in London and the South-East.
Ruth Dobson et al. Eligibility for anti-amyloid treatment: preparing for disease modifying therapies for Alzheimer’s disease. Journal of Neurology, Neurosurgery and Psychiatry. 11 June 2024. DOI 10.1136/jnnp-2024-333468