The drugs Donepezil ( Aricept ), Rivastigmine ( Exelon ), Galantamine ( Remynil ), and Memantine ( Ebixa ) should no longer be prescribed on the National Health Service ( NHS ) to treat Alzheimer's disease according a new draft guidance from the National Institute for Clinical Excellence ( NICE ).

Nice says the drugs are not effective enough to justify the cost to the NHS in England and Wales.

NICE’s preliminary proposal

- Donepezil, Rivastigmine and Galantamine are not recommended for use in the treatment of mild to moderate Alzheimer’s disease ( AD ).

- Memantine is not recommended for the treatment of moderately severe to severe AD, except as part of ongoing or new clinical studies that are designed to generate robust and relevant data on long-term outcomes, disease progression, quality of life and costs.

- People currently receiving Donepezil, Rivastigmine, Galantamine and Memantine, whether as routine therapy or as part of a clinical trial, may be continued on therapy ( including at the conclusion of a clinical trial ) until it is considered appropriate to stop.

Alzheimer’s disease, the most common form of dementia, is a primary degenerative cerebral disease.
Progression is characterised by a deterioration in cognition ( thinking, conceiving, reasoning ), functional ability ( activities of daily living ), and behaviour and mood.
AD progresses from diagnosis to death in about 5-7 years.

NICE’s Committee reviewed the data available on the clinical and cost effectiveness of anticholinesterase inhibitors ( Donepezil, Rivastigmine and Galantamine ) and Memantine.

The Committee noted that there is little positive randomised evidence available on the long-term gain of the anticholinesterase inhibitors in mild to moderate Alzheimer disease .
The Committee observed that the randomized controlled trials ( RCT ) evidence on outcomes of importance to patients and carers, such as quality of life and time to institutionalisation, is limited and largely inconclusive.

For moderately severe to severe Alzheimer disease, the Committee considered evidence from three trials of Memantine and concluded that the evidence for the clinical effectiveness of Memantine was currently insufficient.

Source : NICE, 2005

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