Aricept & Alzheimer’s

Thousands of patients with advanced Alzheimer’s disease could benefit from drugs, research suggests.

A study in the the New England Journal of Medicine found that patients who stayed on the dementia drug Aricept had a slower decline in their memory.

The drug tends not to be prescribed once sufferers progress beyond moderate symptoms.

Medicines regulator NICE said its guidelines supported continuing treatment where there were benefits.

The patent for the medicine Aricept, which is used to treat Alzheimer’s disease, expired recently. Much cheaper versions under the generic name donepezil are already available for about £12 a month.

The researchers say their new evidence could lead to twice as many Alzheimer’s sufferers worldwide being given medication.

The trial involved 295 Alzheimer’s patients in England and Scotland who had been taking Aricept.

One set were given placebo tablets while another set stayed on Aricept. A third set were given another drug, Ebixa, or memantine, which is usually prescribed only in the later stages of Alzheimer’s.

The fourth batch of patients received a combination of both drugs.

The researchers assessed each group for a year, looking at their cognitive scores on factors like memory, and also at how well they coped with everyday tasks such as dressing and eating.

The drugs were unable to halt the decline of patients, but they slowed it down.

The study’s lead author, Professor Robert Howard from King’s College London Institute of Psychiatry, said: “For the first time, we have robust and compelling evidence that treatment with these drugs can continue to help patients at the more severe stages.


“Patients who continued taking donepezil were about four months ahead in how they were able to remember, communicate and perform daily tasks than those who stopped taking the drugs.

“It means a lot to doctors and carers to see differences like that. These improvements were sustained throughout the year.

“It’s fair to say that both drugs have independent, positive effects at this stage of dementia. I’m advising hospital colleagues to continue patients on donepezil, when it’s tolerated, and to add in memantine.”

About 500,000 people in the UK are thought to have Alzheimer’s disease – with only about 10% who are in the earlier stages currently on drug treatment.

NHS funding of dementia drugs has been controversial in the past. The National Institute for Health and Clinical Excellence (NICE) set restrictions in 2006, which campaigners tried to overturn in court.

A year ago, revised NICE guidelines accepted that medicines including Aricept were cost-effective and could be prescribed earlier in the course of the disease.

Professor Clive Ballard from the Alzheimer’s Society, which part-funded the trial alongside the Medical Research Council, said: “Usual practice has been to discontinue the treatment once patients have declined to a certain stage.

“This trial suggests the default position should be the other way round, because most people are benefiting.

“It’s not so much the NICE guidance that needs to change – but how clinicians interpret it.”

NICE said its guidelines did not include any specific recommendations on when to discontinue medicines.

Dr Simon Ridley from Alzheimer’s Research UK said: “Trials such as this are extremely important for informing decisions about the way medication is prescribed.

“It would be helpful to see longer-term trials to determine exactly how long the benefits seen in this study might last.

“Sadly we still lack a treatment that can stop Alzheimer’s disease in its tracks.”

Homoeopathy condemned

Britain’s foremost professor of complementary medicine today launches a withering attack on the provision of homoeopathy on the NHS.

Professor Edzard Ernst of Exeter University says the use of state funding to provide a treatment which works no better than a placebo cannot be justified.

Homoeopathy may also be dangerous where it is subsituted for orthodox treatments of proven efficacy and involves doctors in deceiving their patients about the true value of the medicines they provide, he says.

“Homeopathy could be (and often is) used as an alternative to effective interventions. For example, the advice from homeopaths not to immunise has become a major cause of low vaccination rates. Also, the strategy of using homeopathy as a benign placebo can only work if clinicians do not tell the truth to their patients,” he writes in The Biologist.

The attack is the latest on the 200-year-old practice, introduced by the German Physician Samuel Hahnemann, which today has millions of adherents all over the world. It is based on the principle that “like cures like” and its tinctures are made up from substances that produce the symptoms the patient is suffering from and then repeatedly diluting them until no molecules of the original remain.


Professor Ernst says this disregards most of what we know about physiology. The principle that the more a substance is diluted, the greater its effect is unscientific. “It is in contrast with the laws of physics, chemistry and pharmacology. Homeopathy is thus biologically implausible.”

Homoeopaths claim that even very low concentrations of their tinctures have been shown to differ from pure water. But Professor Ernst said even if that were true it would not explain their claimed positive effects. “The water in my kitchen sink differs from pure water after I have done the washing up, but this does not mean it is good for my health.”

The NHS spends an estimated £4 million a year on providing homoeopathic treatment. Two years ago an investigation by a Commons committee concluded that the funding should cease. The Science and Technology Committee said there was no evidence that it worked, and to continue funding it would divert NHS funds from more effective treatments and undermine the principle that government funding in health should be evidence based.

Dr Mark Downs, Chief Executive of the Society of Biology, said: “The UK spends literally billions of pounds every year ensuring that the new and existing conventional medicines we take are effective, safe and fit for purpose. It makes no sense to allow other treatments to be made available through public expenditure without application of the same rigorous standards. That is what is happening with homeopathic treatments. It needs to stop.”