Pharmacological treatment and use of monoclonal antibodies in Alzheimer’s disease: Analysis on a medical management in Argentina

Abstract

Background Alzheimer’s disease (AD) is the most common cause of cognitive impairment and dementia. The objective of this work is to describe the pharmacological management of AD and the opinion on future pharmacological therapies in Argentina. Method A cross‐sectional, descriptive study was carried out. An opinion anonymous survey about pharmacological treatments was designed. The survey was distributed electronically by the Argentine Neurology Society (ANS) to physicians who assessment patients with cognitive disorders (CD). Answers of specialists in CD (SCD) and non‐specialists in CD (NSCD) about recommended treatments (RT), non‐recommended treatments (NRT) and off‐label therapies were analyzed. Physicians who would indicate or were hesitant to indicate anti‐monoclonal beta amyloid protein antibodies (MABs) therapy were considered as potential MABs prescribers. A descriptive statistical and frequency assessment were performed. Result 155 physicians (10,3% of the total to whom the questionnaire was directed) were surveyed. A 19,35% indicated at least one NRT for dementia and 78,06% prescribed at least one off‐label therapy or a NRT for mild cognitive impairment (MCI). A 31% would indicate MABs. For the management of psychotic symptoms, the most selected drug was quetiapine (88.4%) and for apathy, escitalopram (32,3%). One hundred physicians (64,5% of the total) were considered potential MABs indicators. Nevertheless, 42% of them were unaware of the adverse effects of MABs. Also, 70% would request biomarkers for brain beta amyloid in the initial assessment. There were significant differences in the responses of the SCD and the NSCD regarding indicating MABs (52.17% vs. 23.08, p<0.05) and considering knowledge of its adverse effects (76.09% vs. 38.46%, p<0.05). There were no significant differences between SCD and NSCD in the prescription for RT, NRT, and off‐label therapies. Conclusion In the real life, our study shows that two‐thirds of the respondents would be potential MABs prescribers. At the same time, we identified a high rate of NRTs and off‐label medications indications for patients with CD. These results highlight the need for continuous medical education, particularly in low‐income countries such as Argentina considering the cost of biomarkers and the new therapies like MABs for AD and its impact on public health policies.