Patient Selection Processes for Anti-Amyloid Therapy in United States Veterans After Establishing Criteria for Treatment of Alzheimer’s Disease

Speaker(s)

Mittler B1, Biskach M2, Cambi X2, Li Y2, Reisman J3, Berlowitz D4, Morin PJ2, Zhang R5, Tahami A5, Zhang Q5, Xia W3
1South Texas VA Healthcare System, San Antonio, TX, USA, 2Boston University, Boston, MA, USA, 3Bedford VA Healthcare System, Bedford, MA, USA, 4University of Massachusetts Lowell, Lowell, MA, USA, 5Eisai Inc, Nutley, NJ, USA

OBJECTIVES: In February 2023, the United States Veterans Affairs Healthcare System (VAHS) established criteria for use of newer anti-amyloid therapy (AAT) for Alzheimer’s disease. We evaluated patient selection processes for AAT after issuance of the VAHS criteria.

METHODS: Computerized clinical notes were manually reviewed in the VAHS nationwide databases (March 13, 2023–December 31, 2023). Multiple notes were available per patient over time, and a single patient could fall into multiple categories. Demographics were compared in AAT-treated/untreated groups.

RESULTS: There were 1668 Veterans with clinical notes referencing AAT (study sample). Among them, records documented 49.7% with mild cognitive impairment (MCI) and 33.3% Alzheimer’s dementia (AD). The sample’s mean age was 76.2 years; 3.8% were Female, 9.2% were Black vs 81.1% White, and 3.8% were identified as Hispanic vs 90.6% non-Hispanic. We found, in parallel, 1139 patients with discussion with clinicians on AAT as an option, 147 considered potentially suitable for AAT, 44 scheduled for AAT, and 25 undergoing AAT infusions. Another 19 patients were being monitored post-AAT initiation. Five patients were treated with AAT, but then stopped. Also, 629 patients were not considered candidates for AAT at the time of the note (study window). Within the study sample, 6.8% of patients identified with AD and 2.8% with MCI were treated with AAT, 3.2% of women and 4.5% of men were AAT-treated, and 5% in both Black and White race groups were AAT-treated. Age was comparable between AAT-treated and untreated patients (76-77 years).

CONCLUSIONS: Clinical processes in treatment decision-making in the VAHS were examined during our study window. In the study sample, 4.4% of patients were being prepared for or treated with AAT; 37.7% were not considered candidates for AAT. We did not observe race or sex-based differences in patient selection for AAT.

Code

RWD161

Topic

Epidemiology & Public Health, Study Approaches

Topic Subcategory

Electronic Medical & Health Records, Public Health

Disease

Geriatrics, Neurological Disorders