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How many patients are eligible for disease-modifying treatment in Alzheimer’s disease? A French national observational study over 5 years

Stéphane Epelbaum 1, 2, 3, 4 Claire Paquet 5 Jacques Hugon 6 Julien Dumurgier 6, 7 David Wallon 8 Didier Hannequin 9 Thérèse Jonveaux 10 Annick Besozzi 11 Stéphane Pouponneau 12 Caroline Hommet 12 Frédéric Blanc 13 Laetitia Berly 13 Adrien Julian 14 Marc Paccalin 15 Florence Pasquier 16 Julie Bellet 17 Claire Boutoleau-Bretonnière 18 Thiphaine Charriau 19 Olivier Rouaud 20 Olivier Madec 20 Aurélie Mouton 21 Renaud David 21 Samir Bekadar 22 Roxane Fabre 21 Emmanuelle Liegey 23 Walter Deberdt 24 Philippe Robert 21 Bruno Dubois 1, 3
1 IM2A - Institut de la Mémoire et de la Maladie d'Alzheimer [Paris]
2 ARAMIS - Algorithms, models and methods for images and signals of the human brain
SU - Sorbonne Université, Inria de Paris, ICM - Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute
3 CHU Pitié-Salpêtrière [AP-HP]
4 Centre de référence sur les démences rares et maladie de Pick
5 Hôpital Lariboisière
6 Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris]
7 BioCANVAS - Biomarqueurs CArdioNeuroVASCulaires
8 CHU Rouen
9 Service de neurologie [Rouen]
10 Service de neurologie [CHRU Nancy]
11 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
12 CHU Trousseau [Tours]
13 CHU Strasbourg
14 CHU Poitiers - Centre hospitalier universitaire de Poitiers
15 Service de gériatrie [Poitiers]
16 Département de neurologie[Lille]
17 CHRU Lille - Centre Hospitalier Régional Universitaire [Lille]
18 Service de neurologie [Nantes]
19 CHU Nantes - Centre hospitalier universitaire de Nantes
20 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
21 CHU Nice - Centre Hospitalier Universitaire de Nice
22 ICM - Institut du Cerveau et de la Moëlle Epinière = Brain and Spine Institute
23 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
24 Eli Lilly and Company [Indianapolis]
Abstract : Objective We aimed to study the epidemiology of the prodromal and mild stages of Alzheimer’s disease (AD) patients who are eligible for clinical trials with disease-modifying therapies. Settings We analysed two large complementary databases to study the incidence and characteristics of this population on a nationwide scope in France from 2014 to 2018. The National Alzheimer Database contains data from 357 memory centres and 90 private neurologists. Data from 2014 to 2018 have been analysed. Participants Patients, 50–85 years old, diagnosed with AD who had an Mini-Mental State Exam (MMSE) score of ≥20 were included. We excluded patients with mixed and non-AD neurocognitive disorders. Primary outcome measure Descriptive statistics of the population of interest was the primary measure. Results In the National Alzheimer Database, 550 198 patients were assessed. Among them, 72 174 (13.1%) were diagnosed with AD and had an MMSE ≥20. Using corrections for specificity of clinical diagnosis of AD, we estimated that about 50 000 (9.1%) had a prodromal or mild AD. In the combined electronic clinical records database of 11 French expert memory centres, a diagnosis of prodromal or mild AD, certified by the use of cerebrospinal fluid AD biomarkers, could be established in 195 (1.3%) out of 14 596 patients. Conclusions AD was not frequently diagnosed at a prodromal or mild dementia stage in France in 2014 to 2018. Diagnosis rarely relied on a pathophysiological marker even in expert memory centres. National databases will be valuable to monitor early stage AD diagnosis efficacy in memory centres when a disease-modifying treatment becomes available.
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INSERM | SORBONNE-UNIVERSITE | USPC | SU-MEDECINE | ICM | INRIA | CNRS | UNIV-NANTES | UNIV-PARIS7 | UNIV-PARIS13 | COMUE-NORMANDIE | SORBONNE-PARIS-NORD | UNIV-PARIS | SU-TI

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Stéphane Epelbaum, Claire Paquet, Jacques Hugon, Julien Dumurgier, David Wallon, et al.. How many patients are eligible for disease-modifying treatment in Alzheimer’s disease? A French national observational study over 5 years. BMJ Open, BMJ Publishing Group, 2019, 9 (6), pp.e029663. ⟨10.1136/bmjopen-2019-029663⟩. ⟨hal-02165245⟩

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