Scottish guidance backs drugs for mild dementia

NICE has come under further pressure to change draft guidelines on drugs for Alzheimer's disease after Scottish guidelines backed using the drugs for patients with mild forms of the disease, as well as moderate-to-severe forms.

The Scottish Intercollegiate Guidelines Network (SIGN), made its recommendations solely on evidence of clinical effectiveness. Its guidance, published last week, recommended that donepezil (Aricept), galantamine (Reminyl) and rivastigmine (Exelon) could all be used for the treatment of cognitive decline and associated symptoms in patients with mild-to-moderate Alzheimer's disease.

It also said that galantamine could benefit people with mixed dementias, while rivastigmine shows benefits for people with dementia with Lewy bodies.

The SIGN guideline agrees with the draft NICE technology appraisal on drugs for Alzheimer's disease in not recommending memantine.

But its recommendations on the use of cholinesterase inhibitors do not concur with the NICE draft guidance, which advises restricting prescribing of the three drugs to patients with moderate-to-severe Alzheimer's disease.

In contrast, the SIGN guideline states that the evidence shows 'significant benefits' of rivastigmine in mild-to-moderate Alzheimer's disease, that galantamine is effective for the maintenance of cognition in people with mild-to-moderate Alzheimer's and that severity of Alzheimer's disease 'should not be a contraindication' to the use of donepezil.

Berkshire GP Dr Patrick Brooke, who has an interest in dementia, said: 'The SIGN advice may fly in the face of what NICE wants to be done but it's in keeping with what is held to be best practice around the world.'

Dr Brooke added that the SIGN recommendation increased the pressure on NICE to extend prescribing of cholinesterase inhibitors to patients with mild Alzheimer's.

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