Lecanemab: Bittersweet moment for Alzheimer’s patients – but hope of treatment is still possible
This is a bittersweet moment for people living with Alzheimer’s disease and their families.
Hopes had been high that for the first time they would have access to a treatment that could slow the decline in memory and thinking.
When a pivotal clinical trial was released last year doctors hailed lecanemab as a game-changer, one that could delay the need for care and give families more time together.
But while the medicine’s regulator has agreed that the drug can be prescribed, the NHS spending watchdog has ruled in draft guidance that it is too expensive to justify the benefits.
Unusually that isn’t just because of the cost of the drug.
It’s also the resource implications for the NHS of organising fortnightly infusions for so many people. And then there is the careful diagnosis and intensive monitoring that is needed to keep patients safe.
Lecanemab is a potent drug. It clears the clumps of abnormal protein called amyloid that build up in the brains of people with Alzheimer’s.
Lecanemab is a potent drug that can cause dangerous brain swelling
But in doing so it can sometimes cause dangerous swelling and bleeding in the brain.
So doctors need to be sure patients really have Alzheimer’s before they start treatment.
That can only be done at the moment with expensive PET brain scans or samples of spinal fluid – and the NHS doesn’t have enough of the right machines or staff.
And patients also need regular checks with an MRI scanner to check there are no side effects in the brain.
All in all, the National Institute for Health and Care Excellence (NICE) said it wasn’t worth all the resources just to delay the slide from mild to moderate disease by about four to six months.
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The decision applies to England – Wales and Northern Ireland often follow that lead. Scotland’s spending watchdog has yet to make a decision.
So where does this leave patients?
Those who have the funds will be able to pay for private care. In the US that’s upwards of £20,000 a year. It will feel unfair to many that availability is only there for the privileged.
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But some doctors argue that although the drug was a milestone – the first to have an effect – the effect was relatively modest.
A healthy lifestyle can also slow the progress of the disease – a good diet, lots of exercise, not smoking and maintaining social connections are really important.
Decades of research are beginning to pay dividends. Lecanemab is the first of many drugs coming down the tracks. Each will have to be judged on its merits.
But sometime soon it will be possible to give people the hope of treatment.
Large groups of youths have been throwing fireworks, bricks and bottles at police in Edinburgh, during a night of disorder across the city.
Video posted online shows officers responding to Bonfire Night incidents in the Sighthill, Niddrie, Gracemount and Gilmerton areas.
Riot police have been seen on the streets of Edinburgh, wearing helmets and carrying shields, as fireworks were lit and exploded around them.
Footage from Gilmerton, a suburb in the southeast of the city, also showed burning debris in the street as youths rode on bicycles.
Police in Edinburgh were deployed to several areas, including the suburb of Gilmerton
Police were given extra stop and search powers in certain areas following “intelligence” about planned disorder and firework-related crime.
Superintendent Neil Wilson said: “We are currently responding to incidents of disorder involving large groups of youths throwing a range of objects, including fireworks, bricks and bottles, across Edinburgh.”
A helicopter was also deployed as part of Operation Moonbeam, aimed at supporting local police in tackling fireworks-related offences.
Officers used shields to take cover from fireworks
Meanwhile Lothian Buses withdrew all services from the Niddrie area for safety reasons.
Niddrie was also the scene of disorder on 31 October, when police and public transport vehicles were pelted with fireworks and bricks.
Youths rode on bicycles near officers, as debris burned in the street
On Tuesday, officers in Glasgow seized a “significant quantity” of fireworks from a van in the Drumchapel area which it is alleged were being “sold to the general public, including children”.
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Scotland’s first fireworks control zones (FCZ) are in place in parts of Edinburgh and Glasgow from 1 to 10 November.
Those convicted of setting off a firework within a FCZ face a fine of up to £5,000 and up to six months in jail.
Meanwhile, it appears the famous Lewes bonfire night celebrations in East Sussex went off without incident after police urged people not to attend because of overcrowding concerns.
Effigies of Nigel Farage and Paula Vennells were burnt in Lewes Pic: PA
The so-called “bonfire capital of the world” is famous for burning effigies of controversial politicians and celebrities.
This year they included former Post Office chief executive Paula Vennells and Reform UK leader Nigel Farage.
The Queen is unwell with a chest infection and has withdrawn from her engagements this week, Buckingham Palace has announced.
A palace spokesperson said Camilla’s doctors “have advised a short period of rest” and added that “with great regret, Her Majesty has therefore had to withdraw from her engagements for this week”.
They added the Queen “very much hopes to be recovered in time to attend this weekend’s Remembrance events as normal”.
“She apologises to all those who may be inconvenienced or disappointed as a result,” they said.
It is understood the Queen is currently resting at home and is under doctor’s supervision.
Birgitte, the Duchess of Gloucester, has stepped in on Camilla’s behalf to attend the annual opening of the Field of Remembrance at Westminster Abbey on Thursday.
The Queen has also withdrawn from a Buckingham Palace reception for Olympic and Paralympic athletes hosted by the King on the same evening.
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Camilla recently returned from an overseas tour of Australia and Samoa. No further details regarding her illness or treatment have been released.
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