Perceptions of Value and Adoption of ADRD Modifying Drugs Among Physicians Around the U.S

TL;DR

This study explores how U.S. physicians perceive and adopt new Alzheimer's drugs that target amyloid, highlighting differences in opinions and challenges in implementation.

Contribution

The study provides new insights into physician perceptions and real-world adoption challenges of recently approved Alzheimer's drugs.

Findings

Physicians show a wide range of attitudes from cautious to supportive of the new Alzheimer's medications.

Neurologists are more likely to prescribe the drugs compared to geriatricians.

Communication and implementation of the drugs vary significantly across practices and health systems.

Abstract

Following recent FDA approvals in the U.S. of two anti-amyloid medications for Alzheimer’s Disease, lecanemab and donanemab, we aimed to examine clinicians’ perceptions of the value of and real-world adoption experiences with prescribing these medications. While these monoclonal antibody treatments are the first medications to clear amyloid in the brain, they come with significant treatment burdens and risks. Our objective was to better understand the risk-benefit evaluations physicians make when selecting candidates for treatment; the practice-level, insurance, and health system obstacles they’ve had to navigate when implementing these complex medications into their practices; and how they communicate the risks and benefits to patients and their families. Using purposive and snowball sampling, we interviewed 10 physicians including geriatricians, neurologists and psychiatrists to understand the drivers of and barriers to adoption of these medications by physicians. We identified 5 themes from our qualitative interviews: 1) a broad continuum of wariness to avid proponent of the medications; 2) differences in a propensity to prescribe these medications and approaches to care between different clinical specialties, with strong support from neurologists and a more cautious approach from geriatricians; 3) varied communication styles in how physicians present the risks and benefits with patients and their families, 4) significant variation in practice and health-system implementation, from a planned approach to a less organized approach, and 5) clinicians facing shifting roles of balancing hope with limited data, managing ethical complexity, and bearing the emotional weight of guiding patients through novel therapies.