Patient journey and decision processes for anti-amyloid therapy in Alzheimer's disease

Brant Mittler¹, Xavier Cambi^{2

3}, Morgan Biskach^{2

3}, Joel Reisman^{4

5}, Ying Wang^{6

7}, Dan Berlowitz⁸, Peter Morin⁹, Donald R Miller¹⁰, Karla Brandao-Viruet¹¹, Sophie J Clare², Kevin Z Xia¹², Amir Abbas Tahami Monfared^{13

14}, Michael Irizarry¹³, Quanwu Zhang¹³, Weiming Xia^{15

16

17}

Affiliations

¹ UT Health San Antonio, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
² Department of Pharmacology, Physiology and Biophysics, Boston University Chobanian & Avedisian School of Medicine, 700 Albany Street, Boston, MA, 02115, USA.
³ Geriatric Research Education and Clinical Center, Bedford VA Healthcare System, Building 70, Room 202, 200 Springs Road, Bedford, MA, 01730, USA.
⁴ Department of Biological Science, Kennedy College of Sciences, University of Massachusetts Lowell, One University Avenue, Lowell, MA, 01854, USA.
⁵ Center for Healthcare Optimization and Implementation Research, Bedford VA Medical Center, 200 Springs Road, Bedford, MA, 01730, USA.
⁶ Research Service, VA Bedford Healthcare System, 200 Springs Road, Bedford, MA, 01730, USA.
⁷ Wentworth Institute of Technology, 550 Huntington Avenue, Boston, MA, 02115, USA.
⁸ Department of Public Health, Dugan Hall, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, 883 Broadway Street, Lowell, MA, 01854, USA.
⁹ Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, 725 Albany Street, Boston, MA, 02118, USA.
¹⁰ Center for Population Health, Department of Biomedical and Nutritional Sciences, University of Massachusetts, 710 Pawtucket Street, Lowell, MA, 01854, USA.
¹¹ Tufts Medical Center, 800 Washington Street, Boston, MA, 02118, USA.
¹² Frank H. Netter MD School of Medicine, Quinnipiac University, MNH-338, 370 Bassett Road, North Haven, CT, 06473, USA.
¹³ Alzheimer's Disease and Brain Health, Eisai Inc., 200 Metro Boulevard, Nutley, NJ, 07110, USA.
¹⁴ Epidemiology, Biostatistics and Occupational Health, McGill University, 2001 McGill College Avenue, Montreal, QC, H3A 1Y7, Canada.
¹⁵ Department of Pharmacology, Physiology and Biophysics, Boston University Chobanian & Avedisian School of Medicine, 700 Albany Street, Boston, MA, 02115, USA. weiming.xia@va.gov.
¹⁶ Geriatric Research Education and Clinical Center, Bedford VA Healthcare System, Building 70, Room 202, 200 Springs Road, Bedford, MA, 01730, USA. weiming.xia@va.gov.
¹⁷ Department of Biological Science, Kennedy College of Sciences, University of Massachusetts Lowell, One University Avenue, Lowell, MA, 01854, USA. weiming.xia@va.gov.

PMID: 40237866
PMCID: PMC12003442
DOI: 10.1007/s00415-025-13059-3

Patient journey and decision processes for anti-amyloid therapy in Alzheimer's disease

Brant Mittler et al. J Neurol. 2025.

. 2025 Apr 16;272(5):341.

doi: 10.1007/s00415-025-13059-3.

Authors

Affiliations

¹ UT Health San Antonio, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
² Department of Pharmacology, Physiology and Biophysics, Boston University Chobanian & Avedisian School of Medicine, 700 Albany Street, Boston, MA, 02115, USA.
³ Geriatric Research Education and Clinical Center, Bedford VA Healthcare System, Building 70, Room 202, 200 Springs Road, Bedford, MA, 01730, USA.
⁴ Department of Biological Science, Kennedy College of Sciences, University of Massachusetts Lowell, One University Avenue, Lowell, MA, 01854, USA.
⁵ Center for Healthcare Optimization and Implementation Research, Bedford VA Medical Center, 200 Springs Road, Bedford, MA, 01730, USA.
⁶ Research Service, VA Bedford Healthcare System, 200 Springs Road, Bedford, MA, 01730, USA.
⁷ Wentworth Institute of Technology, 550 Huntington Avenue, Boston, MA, 02115, USA.
⁸ Department of Public Health, Dugan Hall, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, 883 Broadway Street, Lowell, MA, 01854, USA.
⁹ Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, 725 Albany Street, Boston, MA, 02118, USA.
¹⁰ Center for Population Health, Department of Biomedical and Nutritional Sciences, University of Massachusetts, 710 Pawtucket Street, Lowell, MA, 01854, USA.
¹¹ Tufts Medical Center, 800 Washington Street, Boston, MA, 02118, USA.
¹² Frank H. Netter MD School of Medicine, Quinnipiac University, MNH-338, 370 Bassett Road, North Haven, CT, 06473, USA.
¹³ Alzheimer's Disease and Brain Health, Eisai Inc., 200 Metro Boulevard, Nutley, NJ, 07110, USA.
¹⁴ Epidemiology, Biostatistics and Occupational Health, McGill University, 2001 McGill College Avenue, Montreal, QC, H3A 1Y7, Canada.
¹⁵ Department of Pharmacology, Physiology and Biophysics, Boston University Chobanian & Avedisian School of Medicine, 700 Albany Street, Boston, MA, 02115, USA. weiming.xia@va.gov.
¹⁶ Geriatric Research Education and Clinical Center, Bedford VA Healthcare System, Building 70, Room 202, 200 Springs Road, Bedford, MA, 01730, USA. weiming.xia@va.gov.
¹⁷ Department of Biological Science, Kennedy College of Sciences, University of Massachusetts Lowell, One University Avenue, Lowell, MA, 01854, USA. weiming.xia@va.gov.

PMID: 40237866
PMCID: PMC12003442
DOI: 10.1007/s00415-025-13059-3

Abstract

Introduction: We utilized the Veterans Affairs Healthcare System administrative database to study the clinical decision-making processes for anti-amyloid therapy (AAT).

Methods: Patients with clinical notes mentioning lecanemab were identified (March 2023-June 2024) for manual review and structured database queries.

Results: From an initial sample (N = 2499), 1064 patients (55,000 notes) were reviewed manually (mean age 76 years; 7.3% women; 9.2% Black; 3.9% Hispanic). The AAT group (n = 56) had lower rates of common comorbidities, except post-traumatic stress disorder, than patients excluded from AAT (n = 528). The documented notes including "Lack of patient interest/resource constraints" (24.6% vs 3.6%), "anticoagulant use" (23.1% vs 10.7%), and "advanced AD" (18.6% vs 0), supplied partial explanations on exclusion vs inclusion.

Discussion: Only 5.3% of patients reached the point of care of being a candidate, scheduled for, or receiving AAT infusion. Patient preference and clinician discretion, especially regarding modifiable factors (e.g., medication regimens), appreciably influence the patient journey to AAT.

Keywords: Alzheimer’s disease; Anti-amyloid therapy; Electronic health records; Lecanemab; Mild cognitive impairment.

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Conflict of interest statement

Declarations. Conflicts of interest: Amir Abbas Tahami Monfared, Michael Irizzary, and Quanwu Zhang are employees of Eisai Inc. The other authors declare no conflict of interest. Informed consent: All clinical notes from the nationwide VAHS database electronic health records (EHR) were searched, and the study was approved by the Bedford VA Healthcare System Institutional Review Board (IRB). Consent was not required for database analysis.

Figures

**Fig. 1**
Categorization by the latest step in patient journey with AAT. ^a1019 patients were randomly selected from the initial sample of 2499 patients with notes referencing AAT; any women who had not been selected (n = 45) were added to enrich their representation to produce a final sample of 1064 patients

See this image and copyright information in PMC

References

1. Guerreiro R, Bras J (2015) The age factor in Alzheimer’s disease. Genome Med 7:106. 10.1186/s13073-015-0232-5 - PMC - PubMed
1. Qiu C, Kivipelto M, von Strauss E (2009) Epidemiology of Alzheimer’s disease: occurrence, determinants, and strategies toward intervention. Dialogues Clin Neurosci 11:111–128. 10.31887/DCNS.2009.11.2/cqiu - PMC - PubMed
1. Casey DA, Antimisiaris D, O’Brien J (2010) Drugs for Alzheimer’s disease: are they effective? P T 35:208–211 - PMC - PubMed
1. Food and Drug Administration (2021) FDA grants accelerated approval for Alzheimer’s drug. https://www.fda.gov/news-events/press-announcements/fda-grants-accelerat..., Accessed on March 26, 2024
1. Food and Drug Administration (2023) FDA grants accelerated approval for Alzheimer’s disease treatment. https://www.fda.gov/news-events/press-announcements/fda-grants-accelerat..., Accessed on March 26, 2024

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Patient journey and decision processes for anti-amyloid therapy in Alzheimer's disease

Affiliations

Patient journey and decision processes for anti-amyloid therapy in Alzheimer's disease

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Research Materials

Miscellaneous