Lecanemab’s benefits are too small and uncertain

The UK Medicines and Healthcare products Regulatory Agency (MHRA) has approved the monoclonal antibody lecanemab for treatment of patients in the early stages of Alzheimer’s disease who have one or no copies of the apolipoprotein E4 (APOE4) gene.1 However, at the same time, the National Institute for Health and Care Excellence (NICE) issued draft guidance against using the drug in the NHS.2 NICE concluded that the treatment effect was “small but meaningful” but that uncertainty remains about long term effects and the economic model for use in practice. NICE is seeking additional information from lecanemab’s manufacturer, Eisai, and NHS England on identified uncertainties and will consider this information together with other stakeholder comments at a second meeting.3

The decision was met with outraged headlines: “Alzheimer’s wonder drug blocked for use on NHS.”4 These largely reflect the collision between raised expectations around this class of drugs and the tiny treatment benefits, serious safety risks, and high costs of the drug and its administration. Attempts to communicate the true magnitude of treatment …