No change from NICE on Alzheimer's

NICE has not backed down over its controversial ruling that patients with mild or severe Alzheimer's disease should not be given cholinesterase inhibitors, leaving doctors with few treatment options.

The final draft NICE appraisal reiterates advice from previous drafts in recommending that donepezil, galantamine and rivastigmine only be given to patients with moderate Alzheimer's disease.

Cholinesterase inhibitors were recommended for use in all Alzheimer's disease patients in 2001. But concerns about cost-effectiveness have led NICE to restrict their use to the moderate stages of the disease.

Despite the improvements in memory and quality of life associated with the drugs, NICE states that unless patients have a mini mental state examination score of 10-20, they should not be given the treatment, which costs around £2.50 a day.

Dr Andrew Dearden, Cardiff GP and chairman of GPC Wales, said: 'This is another case where NICE, which is supposed to look at cost-effectiveness, is looking at cost but not effectiveness.

'I expect some doctors will ignore this as they are ignoring NICE in other areas because it flies in the face of good practice.'

Professor Clive Ballard, director of research at the Alzheimer's Society, said: 'Doctors will be forced into the impossible position of watching patients deteriorate before they prescribe drugs they know will help.'

Dr Ken O'Neil, a Glasgow GP with an interest in dementia, said: 'It is disappointing. Although the medication doesn't work for everybody there are some people who have benefited significantly.'

The rulings will be open to appeal until 15 June. The final appraisal will be published in July.

- NICE technology appraisal

- Live links at GPonline.com

NICE RULING

- Donepezil, rivastigmine and galantamine can only be given to patients with moderate Alzheimer's.

- Memantine can only be given in Alzheimer's as part of a clinical trial.

- Final guidelines will be issued to the NHS next month.

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