Background

Anti-amyloid (AA) monoclonal antibodies are the first disease-modifying therapies for Alzheimer’s disease (AD), but access varies substantially. Across Southeast Asia (SEA), implementation readiness differs greatly, yet region-specific data remain limited. We aim to examine the readiness of healthcare systems across SEA countries to adopt the routine use of AA therapy, given the marked heterogeneity in economic strength and healthcare infrastructure.

 

Method

We conducted a scoping review according to JBI Scoping Review Network and PRISMA Extension for Scoping Reviews guidelines. We systematically searched databases, including PubMed and Ovid MEDLINE, over the past 10 years, up to December 31, 2025. We also identified grey literature using Google Advanced Search and country-specific systematic searches of relevant organizations, such as WHO-IRIS, World Bank, ASEAN Secretariat, national pharmaceutical regulatory agencies, health technology assessment agencies, and ministries of health. We extracted information on diagnostic capacity, regulations, workforce, and financial coverage for data synthesis.

 

Results

We included 22 studies from 2,287 records; the primary reasons for exclusion were non-SEA settings, non-English full-text articles, and the absence of relevant readiness outcomes (Figure 1). This underlines the overall scarcity of AA-related studies based in SEA. Most SEA countries fall below global averages for physician (1.72 per 1,000) and nurse density (3.77 per 1,000), except Brunei, Malaysia, and Singapore for physicians, and Brunei, Indonesia, the Philippines, and Singapore for nurses (Table 1). Comprehensive testing is available in Singapore and Thailand (CSF, blood-based amyloid/tau, and amyloid/tau PET), while Indonesia and Malaysia offer CSF amyloid/tau, with blood-based amyloid testing available only in Indonesia. Only Singapore, Thailand, and Malaysia have approved AA therapies, but neither has a reimbursement programme in place.

 

Conclusion

We highlight a significant disparity in the preparedness for AA therapy across SEA, with limited biomarker access impeding patient identification in most countries.  Greater regional alignment of screening and referral pathways could ensure equitable delivery of AA therapies, mirroring the current success of regional economic cooperation. Further system-level mapping through targeted surveys will inform future implementation strategies.