With no significant drug launches occurring in more than a decade, the overarching treatment paradigms in Alzheimer’s disease (AD) are mostly stable. However, understanding what factors and forces drive neurologists’ clinical decision making across the AD spectrum today provides crucial context for a future market landscape set to expand meaningfully—thanks to a highly dynamic pipeline composed of potentially landmark disease-modifying therapies, new procognitive symptomatic adjuncts, and targeted behavioral treatments. The Current Treatment Overview provides insight into how AD is diagnosed and treated today, while the detailed, expanded analysis for the United States offers deep insights regarding the AD treatment algorithm, supported by real-world evidence where possible, and the rationale behind neurologists’ treatment decisions.

Table of contents

  • Alzheimer's Disease - Current Treatment - Detailed, Expanded Analysis (US)
    • Physician Prescribing Practices
      • Key Findings
      • Patient Characteristics
        • Surveyed Neurologists Manage Alzheimer's Disease Patients Across the Severity Spectrum
        • Healthcare Coverage of Alzheimer's Disease Patients (Survey Data)
        • Presence of Pre-Alzheimer's Disease Patients in Neurologists' Practices (Survey Data)
        • Percentage of Mild, Moderate, and Severe Alzheimer's Disease Patients in Neurologists' Practices (Survey Data)
        • Percentage of Alzheimer's Disease Patients with Comorbid Behavioral Conditions (Survey Data)
      • Treatment Practices
        • Diagnosis and Management of Alzheimer's Disease Patients
        • Neurologists' Management of Alzheimer's Disease Patients (Survey Data)
        • Neurologists' Use of Biomarker Tests in the Diagnosis of Alzheimer's Disease (Survey Data)
        • Influence of Biomarkers on Neurologists' Treatment Practices (Survey Data)
        • Characteristics Used by Neurologists to Identify Pre-Alzheimer's Disease Patients (Survey Data)
        • Most Common Diagnosis Given in Cases of Pre-Alzheimer's Disease (Survey Data)
        • Most Alzheimer's Disease Patients Begin Drug Treatment Soon After Initial Diagnosis
        • Time to Treatment Start (Survey Data)
        • Treatment Rates Vary Across Disease Stage
        • Treatment Rates in Pre-Alzheimer's Disease Patients (Survey Data)
        • Treatment Rates in Mild, Moderate, and Severe Alzheimer's Disease Patients (Survey Data)
        • Treatment Rate for Patients Diagnosed with Alzheimer's Disease (RWD: EHR)
        • Donepezil Remains Firmly Entrenched as the Patient-Share Leader
        • Patient Share for Key Drugs and Drug Classes in Pre-Alzheimer's Disease Patients (Survey Data)
        • Patient Shares for Key Drug Classes Among Drug-Treated Alzheimer's Disease Patients (Survey Data)
        • Patient Shares for AChEIs Among Drug-Treated Alzheimer's Disease Patients (Survey Data)
        • Patient Shares for NMDA Receptor Antagonists Among Drug-Treated Alzheimer's Disease Patients (Survey Data)
        • Key Drug Classes Used to Treat Comorbid Behavioral Symptoms (Survey Data)
        • Neurologists' Preferred Antidepressants for Alzheimer's Disease Patients (Survey Data)
        • Neurologists' Preferred Antipsychotics for Alzheimer's Disease Patients (Survey Data)
        • Patient Share by Product Among Recently Treated Alzheimer's Disease Patients (RWD: Claims)
        • Quarter-over-Quarter Patient Share by Product Among Recently Treated Patients Diagnosed with Alzheimer's Disease (RWD: Claims)
        • Treatment Duration Is Greater Than One Year in Alzheimer's Disease Patients (Survey Data)
        • Duration of Use of Key Drugs and Drug Classes Before Discontinuation (Survey Data)
        • Nonpharmacological Interventions for Alzheimer's Disease Patients
        • Alzheimer's Disease Treatment Patterns Are Highly Consistent and Unlikely to Change in the Near Term
        • The Majority of Alzheimer's Disease Patients Are Still on First-Line Therapies After One Year
        • Percentage of Alzheimer's Disease Patients on First-Line Treatment After One Year (Survey Data)
        • Limited Options Exist for Patients Who Fail First-Line Treatment
        • Most Common First-Line Treatment Choices for Alzheimer's Disease Patients (Survey Data)
        • Most Common Treatment Decision After Patient Fails First-Line AChEI (Survey Data)
        • Product Patient Share by Line of Therapy Among Newly Diagnosed Alzheimer's Disease Patients (RWD: Claims)
        • Donepezil Patient Flow in Newly Diagnosed AD Patients (RWD: Claims)
        • Polypharmacy in Alzheimer's Disease Patients
        • Procognitive Treatment Regimens Used in Alzheimer's Disease Patients (Survey Data)
        • Drug Burden Among Recently Treated Alzheimer's Disease Patients (RWD: Claims)
      • Persistency and Compliance
        • Alzheimer's Disease Patients Exhibit Moderate Compliance and Persistence on Medication
        • Persistency by Drug or Drug Class Among Alzheimer's Disease Patients Over the Past Year (Survey Data)
        • 12-Month Persistency by Therapy Among Recently Treated Alzheimer's Disease Patients (RWD: Claims)
        • Percentage of Alzheimer's Disease Patients Who Switched to Another Therapy or Discontinued Treatment by Key Drug or Drug Class (Survey Data)
        • Compliance Rates by Drug or Drug Class Among Alzheimer's Disease Patients Over the Past Year (Survey Data)
        • 6-Month Compliance (MPR) by Therapy Among Recently Treated Alzheimer's Disease Patients (RWD: Claims)
      • Sequencing of Treatment
        • With Limited Options, Sequencing of Treatment in Alzheimer's Disease Is Uncomplicated
      • Recent/Anticipated Changes in Brand Usage/Treatment Approach
        • The Alzheimer's Disease Treatment Approach Is Highly Stable
        • Drug and Drug Class Usage Changes in the Past Year (Survey Data)
        • Current and Anticipated Brand Patient Shares by Drug and Drug Class (Survey Data)
    • Physician Insight on Medical Practice
      • Key Findings
      • Drivers of Treatment Selection
        • Limited Choice and Limited Benefits Have a Downstream Impact on Treatment Decision-Making
        • Most Common Reasons that Alzheimer's Disease Patients Do Not Receive Drug Treatment for Cognitive Symptoms (Survey Data)
        • Most Common Reasons that Alzheimer's Disease Patients Do Not Receive Drug Treatment for Behavioral Symptoms (Survey Data)
        • Influence of Black Box Warning on Antipsychotic Use in AD Patients (Survey Data)
        • Unsurprisingly, Strong Efficacy Is Not the Main Driver of Use for Most Alzheimer's Disease Therapies
        • Main Drivers of the Use of Cognitive and/or Behavioral Therapies (Survey Data)
        • Many Neurologists Indicate No Obstacles Exist for Key Drugs and Drug Classes Used to Treat Alzheimer's Disease
        • Main Obstacles to the Use of Cognitive and/or Behavioral Therapies (Survey Data)
        • Physicans Have Limited Options for Treatment Switching
        • Clinical Outcomes for Alzheimer's Disease Patients After One Year of Therapy with AChEIs (Survey Data)
        • Clinical Circumstances Under Which Surveyed Physicians Initiate Treatment With Memantine (Survey Data)
        • Reasons for Discontinuation Differ Between Cognitive Therapies and Antipsychotics
        • Common Reasons for Discontinuing Therapy (Survey Data)
        • Denial of Diagnosis Is a Primary Reason for Delaying Treatment of Alzheimer's Disease
        • Rationale for Delaying Treatment Longer Than Six Months (Survey Data)
      • Face-to-Face Product Detailing Effectiveness
        • Brand Detailing Is Limited but May Be Effective
        • The Detailing Reach of Key Alzheimer's Brands Is Limited
        • Sales Representative Access to Surveyed Neurologists
        • Detailing Reach by Brand (Survey Data)
        • Detailing Frequency Within the Past Year by Brand (Survey Data)
        • Surveyed Physicians Are Generally Satisfied with Sales Representatives for Branded AD Therapies
        • Recently Detailed Neurologists' Satisfaction with Sales Representatives (Survey Data)
        • Brand Detailing Messages for Namenda XR and Namzaric Are Similar
        • Messages from Recent Brand Detailing (Survey Data)
    • Methodology
      • Primary Market Research Methodology
      • Distribution of Surveyed Physicians' Regions of Practice (Survey Data)
      • Location of Surveyed Physicians' Primary Practice (Survey Data)
      • Surveyed Physicians' Number of Years in Practice (Survey Data)
      • Number of Patients Managed Per Month by Surveyed Physicians (Survey Data)
      • Primary Practice Types Among Surveyed Physicians (Survey Data)
      • Percentage of Surveyed Physicians Who Consult/Treat Patients Living in a Nursing Home or Long-Term Care Facility (Survey Data)
      • RWD Methodology
      • Limitations of Comparative Analyses Between Data Sources
    • Appendix
      • Real-World Data
        • Gender Distribution Among Patients Diagnosed with Alzheimer's Disease (RWD: EHR)
        • Race Distribution Among Patients Diagnosed with Alzheimer's Disease (RWD: EHR)
        • Age Distribution Among Patients Diagnosed with Alzheimer's Disease (RWD: EHR)
        • Body Mass Index Distribution Among Patients Diagnosed with Alzheimer's Disease (RWD: EHR)
        • Treatment Duration by Product Among Recently Treated Alzheimer's Disease Patients (RWD: Claims)
        • Source of Business by Product Among Recently Treated Alzheimer's Disease Patients (RWD: Claims)
        • Quarter-over-Quarter Product Patient Share by First Line of Therapy Among Newly Diagnosed Alzheimer's Disease Patients (RWD: Claims)
        • Quarter-over-Quarter Product Patient Share by Second Line of Therapy Among Newly Diagnosed Alzheimer's Disease Patients (RWD: Claims)
        • Quarter-over-Quarter Product Patient Share by Third Line of Therapy Among Newly Diagnosed Alzheimer's Disease Patients (RWD: Claims)
        • Progression Rates from First Line of Therapy Among Newly Diagnosed Alzheimer's Disease Patients (RWD: Claims)
        • Progression Rates from Second Line of Therapy Among Newly Diagnosed Alzheimer's Disease Patients (RWD: Claims)
        • Monotherapy vs. Combination Therapy Use by First Line of Therapy Among Newly Diagnosed Alzheimer's Disease Patients (RWD: Claims)
        • Monotherapy vs. Combination Therapy Use by Second Line of Therapy Among Newly Diagnosed Alzheimer's Disease Patients (RWD: Claims)
        • Monotherapy vs. Combination Therapy Use by Third Line of Therapy Among Newly Diagnosed Alzheimer's Disease Patients (RWD: Claims)
        • Drug Burden by Line of Therapy Among Newly Diagnosed Alzheimer's Disease Patients (RWD: Claims)
        • Combination Therapies by First Line of Therapy Among Newly Diagnosed Alzheimer's Disease Patients (RWD: Claims)
        • Combination Therapies by Second Line of Therapy Among Newly Diagnosed Alzheimer's Disease Patients (RWD: Claims)
        • Combination Therapies by Third Line of Therapy Among Newly Diagnosed Alzheimer's Disease Patients (RWD: Claims)
        • Persistency Sample Sizes Among Recently Treated Alzheimer's Disease Patients (RWD: Claims)
        • Ranges of Medication Possession Ratios Among Recently Treated Alzheimer's Disease Patients (RWD: Claims)
        • Donepezil Patient Flow in Recently Treated AD Patients (RWD: Claims)
        • Memantine IR Patient Flow in Newly Diagnosed AD Patients (RWD: Claims)
        • Memantine IR Patient Flow in Recently Treated AD Patients (RWD: Claims)
        • Namenda XR Patient Flow in Newly Diagnosed AD Patients (RWD: Claims)
        • Namenda XR Patient Flow in Recently Treated AD Patients (RWD: Claims)
        • Rivastigmine Patch Patient Flow in Newly Diagnosed AD Patients (RWD: Claims)
        • Rivastigmine Patch Patient Flow in Recently Treated AD Patients (RWD: Claims)
        • Progression Patterns of Key Therapy Sources Among Alzheimer's Disease Patients (RWD: Claims)

Author(s): Tamara Blutstein, PhD

Tamara Blutstein is a Senior Business Insights Analyst on the Central Nervous System, Pain, and Ophthalmology team. She is responsible for analyzing and forecasting pharmaceutical markets, primarily in Neurology indications, with specific expertise in Alzheimer’s disease, Parkinson’s disease, and ischemic stroke.

Prior to joining the company, Tamara was a postdoctoral fellow at Tufts University School of Medicine, where she studied the role of gliotransmission in the regulation of sleep and sleep homeostasis. She earned a Ph.D. in neuroscience from the University of Maryland School of Medicine where she conducted research on the role of gonadal hormones in modulating neuronal-glial communication. She holds a B.A. in neuroscience from Drew University.


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