Introduction:

• Administration of anti-amyloid monoclonal antibodies—lecanemab and donanemab—requires confirmation of amyloid pathology, biweekly to monthly infusion visits, and frequent MRI monitoring to assess for ARIA, including brain edema and microbleeds.

• Initiation of these medications requires prior authorization from the patient’s insurance provider or payer.
• Optimal social and economic determinants of health, along with access to dementia specialists, are critical for patients to access, navigate, and adhere to these treatments.
• We examined anti-amyloid drug use across regions, patient demographics, and prescriber specialty from 2023 to 2025.

Method:

• Analyzed Epic Cosmos data generated through collaboration with a community of Epic health systems, including >304 million patient records from >2,133 hospitals and 48.8K clinics.
• Reported differences in drug utilization by age, sex, race/ethnicity, insurance coverage, and region from 2023 to 2025.
• Described drug utilization by MCI vs ADRD, frailty, comorbidity, rural/urban residence, and prescriber type.

Result:

• Described drug utilization by MCI vs ADRD, frailty, comorbidity, rural/urban residence, and prescriber type
• Most patients receiving anti-amyloid therapy were treated with lecanemab: 82.9% in 2024 and 70.1% in 2025; majority of the patients were urban residents
• Among treated patients, 75.2% had a prior diagnosis of MCI before treatment initiation, with an average of 2.78 comorbidities and a frailty score of 0.22.
• The most common prescriber specialty was neurology

Conclusin:

• The number of treated patients increased 2.6-fold from 2024 to 2025.
• About three-quarters of treated patients had MCI, moderate comorbidity burden, and relatively lower frailty, consistent with the clinical profile of patients eligible for anti-amyloid therapy.
• Disparities in use were observed: majority treated were non-Hispanic White patients and urban residents
• Improving access to anti-amyloid therapies for all eligible patients—within a shared decision-making framework—will require public health policy and practice reforms that address socioeconomic drivers of disparities in the drug access and adherence.