The National Institute for Health and Care Excellence (NICE) have today published their final draft guidance on whether two Alzheimer's medicines should be provided on the NHS. Following consultation, their independent committee concluded that the benefits from donanemab (also called Kisunla and made by Eli Lilly) and lecanemab (also called Leqembi and made by Eisai) remain too small to justify the additional cost to the NHS. Senior UK DRI leads respond to the news.
Prof Siddharthan Chandran, Director of the UK DRI said:
“Naturally, there is disappointment that the first breakthrough treatments won’t be available on the NHS. However, this is still a watershed moment and the start of the story. We’ve shown it’s possible to slow Alzheimer’s, and that the disease is tractable. Through research, more affordable and more effective treatments and diagnostics are on the way – and at the UK Dementia Research Institute we’re working to make sure they will reach everyone who needs them."
Prof Tara Spires-Jones, UK DRI Group Leader at Edinburgh, said:
“While people living with Alzheimer’s disease and their families will likely be disappointed by this announcement that two new drugs that modestly slow Alzheimer’s progression will not be provided on the NHS, there is hope for safer, more effective treatments on the horizon. Both lecanemab and donanemab effectively remove toxic amyloid pathology from the brain, but they only slow the progression of symptoms modestly. Neither of these treatments improve symptoms and both come with the potential for serious side effects of brain swelling and brain bleeding. Treatment with these drugs involves intravenous infusions and brain scans to monitor for side effects. This combination of expensive and difficult treatment, potentially dangerous side effects, and modest benefits has led the NICE committee to decide against providing these drugs on the NHS, highlighting the need for more research to improve treatments. There is ongoing work around the world including research in fundamental neuroscience to find new targets, clinical trials of new drugs, and studies of people taking lecanemab and donanemab to determine their long-term effects. I am optimistic that research will lead to safer and more effective treatments.”
Prof Paresh Malhotra, UK DRI Group Leader at Care Research & Technology, said:
“The draft guidance documents from NICE on lecanemab and donanemab mean that these treatments will not be available for people with Alzheimer’s Disease via the NHS. This is not totally unexpected but does create a significant gap between what is done in other countries as well as the private sector, and what will be done for NHS patients. The modest effects and significant costs of these drugs have, understandably, been used to justify these decisions. The treatments would require major infrastructure changes to deliver to all those who are potentially eligible. Perhaps the biggest impact (or lack of it), is that there will be no impetus to change our general approach to make dementia diagnosis faster and to provide longer-term specialist input for people living with Alzheimer’s Disease. New and initially controversial treatments catalysed services and healthcare provision for other neurological conditions such as MS and stroke. People with Alzheimer’s Disease, and Dementia more broadly, will have to continue to wait. In the meantime, we will try to push against the more nihilistic attitudes that are sometimes associated with this very common devastating disease.”
Declared interests:
- Prof Siddharthan Chandran: The UK Dementia Research Institute holds funding partnerships with UK government (MRC, NIHR), charities (BHF, Alzheimer’s Research UK, Alzheimer’s Society, LifeArc, Parkinson’s UK), and industry (Lilly, Eisai, Astex, SPARC, GSK and Ono). Siddharthan Chandran until May 2025 was the academic lead of Neurii, a £5M partnership to deliver patient focused digital health solutions for dementia, part funded by Eisai.
- Prof Tara Spires-Jones: I have no conflicts with this study but have received payments for consulting, scientific talks, or collaborative research over the past 10 years from AbbVie, Sanofi, Merck, Scottish Brain Sciences, Jay Therapeutics, Cognition Therapeutics, Ono, and Eisai. I am also Charity trustee for the British Neuroscience Association and the Guarantors of Brain and serve as scientific advisor to several charities and non-profit institutions.
- Prof Paresh Malhotra: National Specialty Lead for Dementia and Neurodegeneration - NIHR Research Delivery Network, Honorary Consultant Neurologist - Imperial College Healthcare NHS Trust, Serviced Practice Consultant Neurologist - Cleveland Clinic London, NHSE Working Group Member (Lecanemab and Amyloid PET), Trustee - Alzheimer’s Society, Recipient of ‘Drugs Only’ Grant for NIHR funded Trial, Shire/Takeda, Independent Data Monitoring Committee - J&J, Research funding from NIHR, ARUK, Alzheimer’s Society, MRC, DPUK, BHF, Lifearc, FIFA, FA, UK DRI.