Early evening headlines yesterday, on BBC Radio 4 news, announced the “shocking” news that drugs for Alzheimer’s Disease / dementia had been de-listed in France. This story has not been followed-up, and appears to have been dropped quietly; although neither, apparently, has it been retracted or corrected in any transparent manner.
So far as can be discerned, the source of this news is not particularly new. The veracity of this particular news item cannot be verified conclusively, although – if true – it seems odd that no-one has brought this to the attention of UK / world audiences sooner.
“The drugs available in mid-2018 for Alzheimer’s Disease have only minimal and transient efficacy. They have disproportionate, serious and sometimes fatal adverse effects. …In May 2018, France’s Minister for Health took this negative harm-benefit balance into account. She decided that, from 1 August 2018, these drugs – donepezil, galantamine, rivastigmine and memantine – would be delisted, i.e. no longer reimbursed by the national health insurance system”.
Drugs for Alzheimer’s disease: finally delisted in France! [Online]: Prescrire in English [the Prescriber], June 15th 2018. [Médicaments de la maladie d’Alzheimer: enfin non remboursables en France!] Rev. Prescrire. 2018: 38(416).
Corroborative Evidence – Five Months Old
Circumstantial evidence, dating from late May 2018, confirms that the story does indeed have some basis, and may be true (if inexplicably belated):
Alzheimer’s Disease International (ADI) pledges to register anti-dementia drugs on WHO list of essential medicines. [Online]: Alzheimer’s Disease International, May 30th 2018.
Postscript – Proof Positive: October 2018 Update
Mystery explained; BBC News must have been reflecting / promoting the BBC Radio Four network’s own programme content from earlier the same day:
France Delists Alzheimer’s Drugs, Quality of Life After Hip Fracture, Prostate Cancer. London: BBC Radio 4’s Inside Health, October 17th 2018.
The latest NICE guideline on the subject was released in June 2018, so will not be updated in the light of these developments for some time to come.
Monotherapy Versus Combination Therapy?
Uncertain clinical significance…
Lawler, E. [and] Avila, A. (2018). Alzheimer Disease: Monotherapy vs. Combination Therapy. American Family Physician. April 1st 2017; 95(7): 452.
Possibly of interest:
Kennedy, RE. Cutter, GR. [and] Fowler, ME. [et al] (2018). Association of concomitant use of cholinesterase inhibitors or Memantine with cognitive decline in Alzheimer clinical trials: a meta-analysis. JAMA Network Open, 1(7), pp.e184080-e184080.
Galantamine-Memantine Drug Combination Superior to Donepezil-Memantine Combination?
The search for alternative drug combinations continues. For example:
Koola, MM. Nikiforuk, A. [and] Pillai, A. [et al] (2018). Galantamine-memantine combination superior to donepezil-memantine combination in Alzheimer’s disease: critical dissection with an emphasis on kynurenic acid and mismatch negativity. Journal of Geriatric Care and Research (JGCR). 2018, Vol.5(2): pp.57-67.
Hager, K. Baseman, AS. [and] Nye, JS. [et al] (2018). Effect of concomitant use of memantine on mortality and efficacy outcomes of galantamine-treated patients with Alzheimer’s disease: post-hoc analysis of a randomized placebo-controlled study. Alzheimer’s Research and Therapy. November 15th 2016; 8(1): 47.