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

IF 4.8 2区医学 Q1 CLINICAL NEUROLOGY

Journal of Neurology Pub Date : 2025-04-16 DOI:10.1007/s00415-025-13059-3

Brant Mittler, Xavier Cambi, Morgan Biskach, Joel Reisman, Ying Wang, Dan Berlowitz, Peter Morin, Donald R Miller, Karla Brandao-Viruet, Sophie J Clare, Kevin Z Xia, Amir Abbas Tahami Monfared, Michael Irizarry, Quanwu Zhang, Weiming Xia

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引用次数: 0

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.

查看原文本刊更多论文

阿尔茨海默病抗淀粉样蛋白治疗的患者历程和决策过程。

前言：我们利用退伍军人事务医疗保健系统管理数据库来研究抗淀粉样蛋白治疗（AAT）的临床决策过程。方法：在2023年3月至2024年6月期间，对临床记录中提到lecanemab的患者进行人工审查和结构化数据库查询。结果：从初始样本（N = 2499）中，人工审查了1064例患者（55,000条记录）(平均年龄76岁；7.3%的女性;9.2%是黑人;3.9%的西班牙裔)。除创伤后应激障碍外，AAT组（n = 56）的常见合并症发生率低于未接受AAT治疗的患者（n = 528）。文件记录包括“缺乏患者兴趣/资源限制”（24.6%对3.6%），“抗凝剂使用”（23.1%对10.7%）和“晚期AD”（18.6%对0），提供了排除与纳入的部分解释。讨论：只有5.3%的患者达到了候选、计划或接受AAT输液的护理点。患者的偏好和临床医生的判断，特别是关于可改变的因素（例如，药物治疗方案），明显影响患者前往AAT的旅程。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Neurology 医学-临床神经学

CiteScore

10.00

自引率

5.00%

发文量

558

审稿时长

1 months

期刊介绍： The Journal of Neurology is an international peer-reviewed journal which provides a source for publishing original communications and reviews on clinical neurology covering the whole field. In addition, Letters to the Editors serve as a forum for clinical cases and the exchange of ideas which highlight important new findings. A section on Neurological progress serves to summarise the major findings in certain fields of neurology. Commentaries on new developments in clinical neuroscience, which may be commissioned or submitted, are published as editorials. Every neurologist interested in the current diagnosis and treatment of neurological disorders needs access to the information contained in this valuable journal.