The UK Medicines and Healthcare products Regulatory Agency (MHRA) has approved lecanemab, a monoclonal antibody, for treating early-stage Alzheimer's disease in patients with one or no copies of the apolipoprotein E4 (APOE4) gene. This decision arrives as the National Institute for Health and Care Excellence (NICE) has issued draft guidance against its use within the NHS, citing concerns over the drug's limited treatment effect, uncertainties regarding long-term outcomes, and the economic model for its practical application.
NICE acknowledges a "small but meaningful" treatment effect but seeks additional information from lecanemab's manufacturer, Eisai, and NHS England to address identified uncertainties. This information, along with stakeholder comments, will be reviewed at a subsequent meeting. The contrasting perspectives have ignited debate, particularly regarding the balance between the raised expectations surrounding this class of drugs and the modest treatment benefits, potential safety risks, and substantial costs associated with the drug and its administration.
Robert Howard, a professor of old age psychiatry at the University College London, highlights the collision between the heightened expectations for such drugs and the actual magnitude of treatment benefits, coupled with serious safety risks and high costs. The challenge lies in effectively communicating the true extent of lecanemab's treatment effects, considering both clinical outcomes and economic implications for healthcare systems.
