Two widely prescribed Alzheimer’s drugs—donepezil and memantine—are being tested together to see whether they can slow decline in patients with moderate to severe disease, and whether the NHS should keep paying for them. Alzheimer’s disease has no cure, and patients eventually become totally dependent on nursing care. Donepezil is licensed for mild to moderate Alzheimer’s, memantine for moderate to severe stages. They work through different mechanisms in the brain, and some evidence suggests combining them may slow decline more than either drug alone. But the drugs are relatively expensive, and there is ongoing debate about whether they are cost-effective enough to justify NHS funding. The DOMINO-AD Trial will measure whether the combination preserves patients’ ability to perform daily activities and maintain quality of life, and whether any benefits are worth the cost. If the trial shows clear advantages, it could keep both drugs available on the NHS for patients who would otherwise lose access. If it does not, it could lead to changes in prescribing guidelines, saving the health service money that could be redirected to other treatments. Either way, the trial will give clinicians and policymakers the evidence they need to make an informed decision about a common, costly treatment.
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Alzheimer s disease is a devastating and progressive degenerative disorder for which there is no cure or treatment that can halt decline into a state of total dependence upon nursing care. A number of drug treatments have been shown to make small but significant and short-term improvements in some symptoms such as memory function or agitated or withdrawn behaviour in sufferers. Even when clear improvements are not seen with treatment, many studies have shown that those patients who are given these drugs do not decline as rapidly as those who were allocated placebo over a period of 6 months. Donepezil is a cholinesterase inhibitor - a drug which has been licensed for the treatment of patients with mild to moderate Alzheimer s disease. Memantine is a member of a different class of drugs and has a license for the treatment of patients with moderate to severe Alzheimer s disease. The two drugs work in different ways in the brain and there is some evidence that patients who are treated with both drugs together will decline less rapidly than those treated with just one drug. We want to see if this is correct and to see whether the benefits of drug treatments translate into real advantages in terms of preservation of activities of daily life and quality of life in patients. Because these drugs are relatively expensive, there is debate as to whether they are really cost-effective and therefore whether or not they should be available on the NHS. The DOMINO-AD Trial will provide information about the cost-effectiveness of these treatments to inform such a decision.
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