Eligibility for anti-amyloid treatment in a multiethnic community-based study
Lydia Trudel1,2, Joseph Therriault1,2, Arthur C Macedo1,2
1Department of Neurology and Neurosurgery, Montreal Neurological Institute McGill University Montréal Quebec Canada.
Alzheimer'S & Dementia (Amsterdam, Netherlands)
|June 8, 2026
Summary
Few individuals with cognitive impairment meet eligibility for new Alzheimer's treatments like lecanemab and donanemab. Current guidelines limit real-world application in diverse populations, necessitating broader criteria for equitable access.
Area of Science:
- Neurology
- Pharmacology
- Public Health
Background:
- Anti-amyloid monoclonal antibodies (mAbs) like lecanemab and donanemab offer disease-modifying therapy for early Alzheimer's disease (AD).
- Appropriate Use Recommendations (AURs) exist, but real-world eligibility and ethnic disparities in treatment risks are unknown.
Purpose of the Study:
- To determine the proportion of individuals in a multiethnic cohort meeting eligibility for lecanemab and donanemab.
- To assess potential differences in treatment-related risks, specifically amyloid-related imaging abnormalities (ARIA), across ethnic groups.
Main Methods:
- Analysis of 513 cognitively impaired individuals from a multiethnic, community-based cohort (Health and Aging Brain Study-Health Disparities).
- Eligibility assessment based on published AUR criteria for lecanemab and donanemab.
- Estimation of ARIA risk based on APOE ε4 genotype and ethnicity.
Main Results:
- Only 15% of participants met eligibility criteria for either anti-amyloid mAb.
- Black participants showed a numerically higher estimated ARIA burden, though not statistically significant.
Conclusions:
- Current AURs have limited real-world applicability in diverse populations with cognitive impairment.
- Broader inclusion criteria and real-world safety data are crucial for equitable and safe implementation of anti-amyloid therapies.
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