[Dt‐01–01]: Impact of Amyloid Pet on Patient Management: Early Results From the Ideas Study

This is the authors' abstract. We don't add key points for this paper.

The Imaging Dementia-Evidence for Amyloid Scanning (IDEAS) study is evaluating the impact of amyloid PET on patient management and health outcomes in ∼18,500 Medicare beneficiaries age ≥ 65 with mild cognitive impairment (MCI) or atypical dementia who meet Appropriate Use Criteria (AUC) for clinical amyloid PET. Here we report early results assessing changes in patient management in the first 3,979 participants in whom case report forms (CRFs) were completed before and ∼90 days after PET. This represents one-third of the planned enrollment for assessing impact on patient management. All patients were referred by dementia specialists implementing AUC. The pre-PET CRF documented the specialist's management plan assuming no access to amyloid PET, while the post-PET CRF recorded the implemented management plan approximately 90 days following PET with an FDA-approved beta-amyloid ligand. We measured the rate of change between pre- and post-PET management in a composite endpoint that includes one or more of the following: (1) Alzheimer's disease (AD) drug therapy, (2) other drug therapy, or (3) counseling about safety and future planning. The median age of the cohort was 75 (range: 65–95), 50.7% were female, and 90.2% were White or Caucasian. 64.4% of patients were diagnosed with MCI, 35.6% met criteria for dementia. The most common suspected etiology for cognitive impairment prior to PET was AD (76.3%) followed by non-AD neurodegenerative disease (11.9%). Rates of amyloid PET positivity were 54.3% in MCI and 70.5% in dementia. Changes in the composite management endpoint were seen in 67.8% (95% CI: 66.0% - 69.6%) of MCI patients (47.8% change in AD drugs, 36.0% change in other drugs, 23.9% changes in counseling), and in 65.9% (95% CI: 63.4%-68.3%) of dementia patients (47.7% change in AD drugs, 32.2% change in other drugs, 15.3% change in counseling). Secondary management endpoints which showed > 10% pre to post-PET change in the overall population included: neuropsychological testing (17.3%), referrals to AD therapeutic trials (15.0%), and referrals for FDG-PET (13.2%) and MRI (10.2%). Early IDEAS Study data indicate that amyloid PET may have a substantial impact on patient management.