Real World Prescribing: Use of Anti-Amyloid Antibodies in Clinical Practice

Abstract

Anti-amyloid antibody therapy is now available for clinical use in MCI due to Alzheimer's disease and mild Alzheimer's dementia. This symposium will focus on clinical aspects of screening, prescribing and safety monitoring. The first talk will address patient eligibility and therapy implementation. The speaker will discuss disease staging and how to recognize neuroimaging abnormalities and concomitant medications that would exclude patient from eligibility. The speaker will explore use of CSF or amyloid PET to confirm amyloid pathology and use of ApoE genotyping to assess ARIA risk. There will be emphasis on ways to provide treatment specific education to patients and their care partners. Lastly, the speaker will demonstrate infusions orders and utilization of CMS registry for Medicare coverage.The second talk will move to management issues once a patient starts receiving antibody therapy, such as identifying and treating infusion reactions. Our neurologist speaker will define and review the edema and hemorrhage subtypes of Amyloid-Related Imaging Abnormalities (ARIA-E and ARIA-H respectively). The speaker will recommend MRI monitoring schedule and provide strategies to reduce risk and manage ARIA.The final talk will utilize case studies to demonstrate best practices. The speakers will share lessons learned from their collective expertise. The panel acknowledges two different providers on the care spectrum - one being a treating provider and one being a referring provider. Referring providers will learn to create a comprehensive referral, ensuring efficient treatment transition.At time of submission, there are pending issues relevant to this symposium. Commercial insurance and Medicare Advantage plans are currently clarifying their position on drug coverage and patient registry requirement. CMS has proposed a coverage pathway for amyloid PET scans, currently in an open-comment period. There could be an introduction of an AD blood test, but it is unclear if would be acceptable for pathology confirmation. The speakers will address these updates.