- Design
- Retrospective cohort with propensity matching
- Population
- 1,198,362 US patients with MCI or dementia; 1,696 recipients matched
- Primary outcome
- Receipt of and initial adherence to antiamyloid antibodies
- Effect
- 0.2% treated; Black OR 0.14 (95% CI 0.09–0.23); per year of age OR 0.93
Using a US hospital database of nearly 1.2 million people with mild cognitive impairment or dementia, investigators found 2,427 had received aducanumab, lecanemab or donanemab, and compared 1,696 of them with matched non-recipients.
Older age, more comorbidity, Black or Hispanic ethnicity and living in a more deprived neighbourhood were each associated with lower odds of receiving treatment. Among recipients, only higher comorbidity was associated with fewer days of supply.
Some of this reflects appropriate selection: eligibility requires early-stage disease, confirmed amyloid, MRI safety monitoring and limited comorbidity. But the size of the ethnic differences suggests access barriers beyond clinical criteria. Where these drugs are hard to obtain, the more relevant lesson is about who gets the full diagnostic work-up that eligibility depends on.
- Assess eligibility for antiamyloid therapy using stage, amyloid confirmation, MRI findings and anticoagulant use.
- Discuss the need for repeated MRI monitoring and infusion visits before referral.
- Check whether access barriers, rather than clinical criteria, are excluding patients in your service.
- Record comorbidity burden, which was linked to lower adherence once treatment began.
Why it matters
As disease-modifying dementia drugs multiply, who gets diagnosed early determines who benefits.
Don't overread it
Database coding cannot separate inequity from appropriate clinical ineligibility.
The statistics, in plain English
An odds ratio of 0.14 for Black patients means about one seventh the odds of receiving the drug compared with White patients after matching. Matching and regression cannot account for unrecorded eligibility factors such as amyloid status.
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