Barriers and Solutions for Initiating Monoclonal Antibody Therapy in Alzheimer’s Disease
Jeffrey Gelblum1, Katie Yoest2, David Weisman3
1First Choice Neurology, 2MedThink SciCom, 3Abington Neurological Associates, Clinical Research Center
Objective:
To identify obstacles, solutions, and treatment recommendations for initiating therapy with monoclonal antibodies (mAbs) for Alzheimer’s disease (AD) that have been highlighted in published literature.
Background:
Approval of anti-amyloid mAbs represents a substantial advancement in the AD therapeutic landscape, but integrating these therapies into established treatment pathways may be challenging. Understanding known barriers to treatment initiation and recommendations to address these barriers can provide insight into areas in which practical guidance is needed.
Design/Methods:
A targeted literature review was conducted to identify articles describing barriers or recommendations for initiating mAb therapy in AD. Articles were identified from PubMed using terms for specific mAb drug names, AD-related terms, and terms related to general and AD- or mAb-specific barriers. Articles not published in English or without discussion of barriers or recommendations related to treatment implementation were excluded.
Results:
Of 505 articles extracted, 26 met selection criteria. Publications described challenges throughout all phases of AD management, including evaluation, diagnosis, treatment, and monitoring. Candidate evaluation was noted to be complicated by variable use of neurocognitive and behavioral assessments and lack of familiarity with treatment eligibility. Several publications emphasized the need to identify patients at risk for adverse events, particularly amyloid-related imaging abnormalities, and to define the role of risk-stratification strategies (eg, genotyping). Resource-related barriers were also highlighted for mAb administration and patient monitoring. Increasing capacity of healthcare systems was recommended to address increased demand for early detection, assessment, and diagnosis of eligible individuals. Additional solutions included infusion administration in diverse care settings and development of monitoring strategies with broader accessibility.
Conclusions:
Published literature describes barriers that impact all stages of anti-amyloid mAb administration. These findings can provide a foundation to identify needs for additional guidance to aid neurologists interested in initiating treatment with mAb therapies.
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