Who gets Alzheimer’s drugs? Race, vulnerability and health status shape access

The first disease-modifying drugs for Alzheimer's disease offer patients the ability to slow cognitive decline by targeting amyloid plaques in the brain.

But a new study suggests that not all patients have the same opportunity to receive these treatments.

Research led by Michigan Medicine found that Black adults had 86% lower odds, and Hispanic adults had 79% lower odds of receiving anti-amyloid medication compared to non-Hispanic white adults.

The findings, published in Neurology, the medical journal of the American Academy of Neurology, highlight potential disparities in access to a new class of Alzheimer's treatments as use of these therapies increases.

“The association we found between race/ethnicity and anti-amyloid medication use raises important questions about how patients are identified, evaluated and ultimately selected for treatment,” said Melissa Elafros, M.D., Ph.D., co-first author and Andrea and Lawrence A. Wolfe Research Professor at University of Michigan Medical School.

“It’s critical that we understand and address the disparities we are seeing today so that as many patients as possible receive benefits.”

From a database of over 1 million adults with mild cognitive impairment or dementia, the research team identified 2,427 patients who received an anti-amyloid medication and compared them to a similar group of untreated patients.

They found that race, ethnicity and health comorbidities were strongly associated with whether patients received treatment.

Participants who faced greater social and economic disadvantages, as measured by factors including income, education and access to housing and neighborhood resources, were nearly half as likely to receive the latest treatments.

Once treatment began, patients were equally likely to take anti-amyloid medications as prescribed, regardless of race or ethnicity.

“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,” said Brian C. Callaghan, M.D., M.S., senior author and Eva L. Feldman, MD, PhD. Professor at U-M Medical School.

“This suggests that interventions should focus on helping eligible patients start therapy, rather than on adherence after treatment begins.”

Additional authors: Lavanya Muthukumar, M.S., and Samuel Terman, M.D., both of University of Michigan. See additional authors online.

Funding/disclosures: This study is funded by a research contract with the American Academy of Neurology.

Callaghan consults for DynaMed, receives research support from the American Academy of Neurology and performs medical legal consultations including consultations for the Vaccine Injury Compensation Program.

Paper Cited: “Predictors of Antiamyloid Medication Utilization and Adherence Among People With Alzheimer Disease and Mild Cognitive Impairment,” Neurology. DOI:10.1212/WNL.0000000000218594