Talking With Patients About the New Anti-amyloid Alzheimer Disease Medications
Authors: Catherine A. Sarkisian, Artem Romanov, John N. Mafi
Journal: Annals of Internal Medicine (2024)

Ideas and Opinions23 January 2024Talking With Patients About the New Anti-amyloid Alzheimer Disease MedicationsCatherine A. Sarkisian, MD, MSHS, Artem Romanov, BA, and John N. Mafi, MD, MPHCatherine A. Sarkisian, MD, MSHSDivision of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, and Geriatrics Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California (C.A.S.)Search for more papers by this author, Artem Romanov, BADivision of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (A.R.)Search for more papers by this author, and John N. Mafi, MD, MPHDivision of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, and RAND Corporation, Santa Monica, California (J.N.M.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M23-3377 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Ms. B is a 78-year-old patient presenting with mild memory loss. She says, “I don't want Alzheimer's. What about those new meds? Do they work?”The number of persons in the United States with Alzheimer disease will approach 14 million by 2060 (1)—a crushing statistic, especially in the absence of effective medical treatments. However, now we have new options: infusions of anti–amyloid-β monoclonal antibodies (mAbs), which reduce the volume of amyloid plaques in the brain and slow disease progression for some patients with mild cognitive impairment and mild dementia. With the U.S. Food and Drug Administration‘s recent approval of aducanumab ...References1. Matthews KA, Xu W, Gaglioti AH, et al. Racial and ethnic estimates of Alzheimer's disease and related dementias in the United States (2015-2060) in adults aged ≥ 65 years. Alzheimers Dement. 2019;15:17-24. [PMID: 30243772] doi:10.1016/j.jalz.2018.06.3063 CrossrefMedlineGoogle Scholar2. Wang C, Song P, Niu Y. The management of dementia worldwide: a review on policy practices, clinical guidelines, end-of-life care, and challenge along with aging population. Biosci Trends. 2022;16:119-129. [PMID: 35466154] doi:10.5582/bst.2022.01042 CrossrefMedlineGoogle Scholar3. Sims JR, Zimmer JA, Evans CD, et al; TRAILBLAZER-ALZ 2 Investigators. Donanemab in early symptomatic Alzheimer disease: the TRAILBLAZER-ALZ 2 randomized clinical trial. JAMA. 2023;330:512-527. [PMID: 37459141] doi:10.1001/jama.2023.13239 CrossrefMedlineGoogle Scholar4. van Dyck CH, Swanson CJ, Aisen P, et al. Lecanemab in early Alzheimer's disease. N Engl J Med. 2023;388:9-21. [PMID: 36449413] doi:10.1056/NEJMoa2212948 CrossrefMedlineGoogle Scholar5. Andrews JS, Desai U, Kirson NY, et al. Disease severity and minimal clinically important differences in clinical outcome assessments for Alzheimer's disease clinical trials. Alzheimers Dement (N Y). 2019;5:354-363. [PMID: 31417957] doi:10.1016/j.trci.2019.06.005 CrossrefMedlineGoogle Scholar6. Wessels AM, Rentz DM, Case M, et al. Integrated Alzheimer’s Disease Rating Scale: clinically meaningful change estimates. Alzheimers Dement (N Y). 2022;8:e12312. [PMID: 35676941] doi:10.1002/trc2.12312 CrossrefMedlineGoogle Scholar7. Widera EW, Brangman SA, Chin NA. Ushering in a new era of Alzheimer disease therapy [Editorial]. JAMA. 2023;330:503-504. [PMID: 37459123] doi:10.1001/jama.2023.11701 CrossrefMedlineGoogle Scholar8. Arbanas JC, Damberg CL, Leng M, et al. Estimated annual spending on lecanemab and its ancillary costs in the US Medicare program. JAMA Intern Med. 2023;183:885-889. [PMID: 37167598] doi:10.1001/jamainternmed.2023.1749 CrossrefMedlineGoogle Scholar9. Socal MP, Odouard IC, Kharrazi H. Ownership and interoperability challenges of Alzheimer monoclonal antibody registries. JAMA Neurol. 2023. [PMID: 38079170] doi:10.1001/jamaneurol.2023.4675 CrossrefMedlineGoogle Scholar10. GeriPal. Amyloid antibodies and the role of the geriatrician: Nate Chin, Sharon Brangman, and Jason Karlawish. 17 August 2023. Accessed at https://podcasts.apple.com/us/podcast/amyloid-antibodies-and-the-role-of-the/id1164272877?i=1000624735117 on 13 December 2023. Google Scholar Author, Article, and Disclosure InformationAuthors: Catherine A. Sarkisian, MD, MSHS; Artem Romanov, BA; John N. Mafi, MD, MPHAffiliations: Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, and Geriatrics Research Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California (C.A.S.)Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (A.R.)Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, and RAND Corporation, Santa Monica, California (J.N.M.)Acknowledgment: The authors thank Christina Frangou for copyediting support and Sitaram Vangala for statistical support.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-3377.Corresponding Author: Catherine A. Sarkisian, MD, MSHS, University of California Los Angeles, David Geffen School of Medicine, Division of General Internal Medicine and Health Services Research, 1100 Glendon, Suite 710, Los Angeles, CA 90024; e-mail, csarkisian@mednet.ucla.edu.Author Contributions: Conception and design: C.A. Sarkisian.Analysis and interpretation of the data: C.A. Sarkisian, J.N. Mafi.Drafting of the article: C.A. Sarkisian, A. Romanov.Critical revision of the article for important intellectual content: C.A. Sarkisian, A. Romanov, J.N. Mafi.Final approval of the article: C.A. Sarkisian, J.N. Mafi.Obtaining of funding: C.A. Sarkisian.Administrative, technical, or logistic support: C.A. Sarkisian, A. Romanov.Collection and assembly of data: C.A. Sarkisian.This article was published at Annals.org on 23 January 2024. 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