Donepezil – Mild to moderate Alzheimer’s dementia – as per NICE TA 217

NICE recommendations, summary of meeting discussions, links to additional supporting docs etc.

A Dementia Assessment and Treatment Pathway is available via the Knowledge Management service.

May 2011: The TAG noted NICE Technology Appraisal 217 (Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease

Review of NICE technology appraisal guidance 111) which states:

The review and re-appraisal of donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer’s disease has resulted in a change in the guidance. Specifically:

– donepezil, galantamine and rivastigmine are now recommended as options for managing mild as well as moderate Alzheimer’s disease, and

– memantine is now recommended as an option for managing moderate Alzheimer’s disease for people who cannot take AChE inhibitors, and as an option for managing severe Alzheimer’s disease.

November 2015:

A Shared Care prescribing Agreement for dementia treatments, including donepezil is now available via: http://nww.knowledgeanglia.nhs.uk/tag/shared_care/dementia_treatments.pdf

November 2015: The TAG and the D&TCG also noted NICE NG 16 (October 2015) Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset

Main recommendations:

* stop smoking

* be more active

* reduce their alcohol consumption

* improve their diet and,

* lose weight and maintain a healthy weight if necessary.

July 2018:

The TAG acknowledged an update of NICE TA 217 (June 2018) and new guidance NG97 on dementia which updates the TA. The guidance included several recommendations regarding drug treatment of dementia which will necessitate review of current arrangements.The item to be returned to the TAG for further discussion.

July 2018:

The D&TC noted in particular

1.6: Medicines that may cause cognitive impairment – which highlighted the need to consider increased anticholinergic burden related to some medicines used long term and the associated risk of cognitive impairment.

September 2018:

The TAG was asked to reconsider in more detail the updated and new recommendations in the above guidance that will impact on current commissioned arrangements for prescribing and monitoring drug treatments for patients with dementia.

The TAG noted that in Suffolk dementia drugs have been classified as “Green” since 2015. Suffolk GP Prescribing Guidance (same guidance used across both CCGs) to be shared and a Task & Finish Group set up to take this item forward.

It was later proposed that this work is discussed by the STP Dementia Group.

November 2018:

The TAG requested that a proposed treatment pathway be submitted for consideration to enable to group to consider revising the current position regarding drug treatment for Dementia / Alzheimer’s Disease.

January 2019: No update on progress was available from the NSFT.

March 2019:

The TAG noted that this item was be managed as part of wider STP-led pathway review work, and therefore agreed to remove it from the TAG’s agenda until commissioning arrangements for this patient group were clarified. No changes to the current traffic light classifications were agreed.

Sept 2021 – Shared Care Agreement updated in Feb 2021 to include all the dementia drugs in one document.  GP to prescribe donepezil, galantamine, rivastigmine or memantine at the dose advised by the specialist at initiation, or any alternative dose determined by the outcome of monitoring provided by the Memory Assessment and Treatment Service (MATS).  Prescribe for up to three months during the initiation phase whilst patient is in the care of the MATS and continue following discharge from specialist service after successful initiation.