Access to anti-amyloid treatment for Alzheimer’s patients requires new care paradigm

Key takeaways:

• Despite FDA approvals, newer treatments for Alzheimer’s may not be covered by insurance.
• A multidisciplinary effort is needed to ensure access to safe and effective treatment.

PHILADELPHIA — Safe and effective ways to introduce anti-amyloid medications for Alzheimer’s disease depends on comprehensive care infrastructure from screening to administration, according to a speaker.

“We’re very excited about these new medications but providing them safely and effectively will require an unprecedented coordination of care,” Liana G. Apostolova, MD, MS, FAAN, associate dean of Alzheimer’s Disease research and a professor at Indiana University, said in a release presented at the American Neurological Association 2023 annual meeting. “I’m not sure that patients and care partners truly understand how much needs to be done to serve them effectively.”

Although initial FDA-approved anti-amyloids such as aducanumab and lecanemab slow AD progression and have been granted coverage by Medicare, other drugs in the pipeline may come with significant health risks, high cost and may require patients to complete multiple steps before receiving their therapy, according to the release.

Apostolova recommended taking several steps to ensure clinicians provide timely access to treatment with a growing number of individuals who have been diagnosed with, or may be diagnosed with, AD. Primary among them is finding ways to resolve a bottleneck when the number of patients seeking treatment overwhelms the number of neurologists available, or the available neurologists cannot keep up with the pace of the expanding body of knowledge.

Another crucial step, she noted, is the creation of a multidisciplinary team of health professionals. The care continuum may include but would not be limited to a team-leading neurologist and a brain health navigator. A team of primary care physicians would be reimbursed for prequalifying patients by compiling comprehensive patient profiles and ordering full work-ups including physical, neurological, genetic and psychological testing.

Additionally, Apostolova said in the release, radiologists, nurses and emergency services personnel who can respond to acute reactions to treatment would be essential to the care continuum.

Finally, should patients choose an IV infusion process for treatment, management of treatment due to limited space or personnel in hospitals that utilize infusions — as well as the sheer number of other cases that may prevent personnel from watching the infusion process closely — presents another challenge, according to Apostolova.

“Developing a well-thought-out and implemented protocol will help ensure patient care is seamless,” Apostolova said in the release. “This coordinated care paradigm could even be the model for other common neurological health conditions, especially those that are treated with biologic therapies.”