Gaps in Antiamyloid Medication Access for MCI and Dementia

TOPLINEAmong patients with mild cognitive impairment (MCI) or dementia, younger age, non-Hispanic White race or ethnicity, fewer comorbidities, and lower socioeconomic vulnerability were associated with a higher likelihood of receiving antiamyloid medications, a study showed. Race and ethnicity remained associated even after adjusting for vulnerability.METHODOLOGYResearchers analyzed the electronic health records of 1,198,362 patients with MCI or dementia from the Vizient database, including data from over 300 medical centers across the US.A total of 2427 participants (0.2%) were prescribed an antiamyloid medication (aducanumab [1%], donanemab [4.2%], or lecanemab [94.4%]), 1696 of whom were matched (1:1) with patients with MCI or dementia not receiving these medications based on the date of diagnosis and follow-up duration. The mean age of all matched participants (N = 3392) was 75.5 years, 56.1% were women, and 80.1% were non-Hispanic White individuals.Researchers gauged social drivers of health with the Vizient Vulnerability Index (VVI), which scores socioeconomic disadvantage by neighborhood.Researchers assessed antiamyloid medication use and among those using lecanemab, they also assessed initial medication adherence (defined as the total number of infusions after the start of treatment until the end of follow-up, among patients who received at least one infusion).Full adjustment considered age, sex, race or ethnicity, US census region, Elixhauser comorbidity score, and all VVI subdomains (as quartiles).TAKEAWAYAfter full adjustment, older age was associated with a lower utilization of antiamyloid medications (adjusted odds ratio [aOR], 0.93; 95% CI, 0.92-0.94), as was higher Elixhauser comorbidity scores (aOR, 0.56; 95% CI, 0.52-0.59).After full adjustment, compared with non-Hispanic White patients, non-Hispanic Black patients had significantly lower odds of receiving antiamyloid medications (aOR, 0.14; 95% CI, 0.09-0.23), as did Hispanic patients (aOR, 0.21; 95% CI, 0.13-0.36) and patients of other non-Hispanic race or ethnicity (aOR, 0.56; 95% CI, 0.40-0.79).Higher overall vulnerability was linked to lower odds of receiving antiamyloid medications (fourth quartile vs first quartile: OR, 0.51; 95% CI, 0.38-0.69), with vulnerability related to education and transportation showing a stronger association.Among patients receiving antiamyloid medications, only higher Elixhauser comorbidity scores were linked to lower initial medication adherence (rate ratio, 0.94; 95% CI, 0.93-0.96); age, sex, race or ethnicity, and overall vulnerability were not associated with initial adherence.IN PRACTICE"Although race, ethnicity and overall vulnerability are associated with whether patients receive an anti-amyloid medication, we found no differences in initial adherence among those who start treatment. This suggests that interventions should focus on helping eligible patients start therapy, rather than on adherence after treatment begins," Brian C. Callaghan, MD, MS, and Eva L. Feldman, MD, PhD, Professor, University of Michigan Medical School, said in a press release.SOURCEThe study was co-led by Evan Lee Reynolds, Michigan State University, East Lansing, Michigan, and Melissa A. Elafros, University of Michigan, Ann Arbor, Michigan. It was published online on October 15 in Neurology.LIMITATIONSThe study used diagnostic codes that may have led to the misclassification of some cases. It lacked data on dementia severity or underlying disease pathology, making it unclear whether patients met the eligibility criteria for antiamyloid medications. VVI did not use individual-level data, and the study lacked information on patient gender, health insurance type, out-of-pocket costs, and apolipoprotein E status. Additionally, patients with no matched control individuals were excluded, and the findings could not be generalized to individuals with nonbinary sex or races or ethnicities other than those studied.DISCLOSURESThe study was funded by the American Academy of Neurology. Disclosure information for the study investigators is available in the original study publication.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.