Preparing for Disease Modifying Therapies

We’ve discussed already the huge amount of energy and resource being invested in the search for disease modifying treatments for Alzheimer’s disease.

When these therapies do become available over the coming years, we will need healthcare services which are appropriately designed to be able to deliver these therapies in the most effective way to the patients who need them.

For many people living with early stage neurodegenerative diseases speed in the rollout of therapies will be critically important. It would be massively inefficient to wait for therapies to be approved before we begin to plan services. This prompted a group of experts from the fields of neurology, psychiatry, neuroradiology and leading charity representatives to release guidance for how these services can and should be shaped now.

The guidance was released as The Edinburgh Consensus. The key points from this expert group consensus are summarised below and you can read the full report here.

• The advent of a disease-modifying treatment would represent a major positive advancement in the management of Alzheimer’s disease.
• This would change the perception of the illness to one that is treatable, which would mark a substantial change in long-held attitudes by the public and healthcare staff.
• Depending on the nature of the patient population for any new medication, redesign of services for Alzheimer’s disease is highly likely to be necessary.
• Healthcare systems will need to identify and engage with prodromal and preclinical populations who might benefit from such interventions. These people may not be in contact with health services or, if they are, this will not be because of Alzheimer’s disease.
• The implications of a disease-modifying treatment would amount to a paradigm shift in clinical approaches to Alzheimer’s disease, but one for which it is possible to prepare.
• Diagnosis, eligibility, and perhaps monitoring of treatment efficacy will require diagnostics to demonstrate evidence of cerebral amyloidosis as an example of precision medicine.
• Realistic planning is needed now to direct the evolution of services to optimise appropriate patient access and prepare protocols for phase IV testing of these treatments to inform real world practice and commissioning decisions.