The Alzheimer’s drug aducanumab (Aduhelm) should not be prescribed to nursing home residents before it is tested in a group that’s representative of that population, long-term care physicians argue.
Although aducanumab has been studied in individuals with mild cognitive impairment and early-stage Alzheimer’s dementia, clinical trials have not shown evidence of safety or efficacy in the long-term care setting, said AMDA–The Society for Post-Acute and Long-Term Care Medicine, in a Wednesday statement.
“We therefore cannot endorse recommending or prescribing aducanumab to post-acute and long-term care (PALTC) residents and patients,” it said.
The group acknowledged the great burden borne by industry workers, who must counsel distraught residents and other patients with diagnoses of dementia, and their families. Even more the reason to proceed with caution, AMDA said.
“It is our responsibility to resist the urge to prescribe a potentially dangerous and ineffective medication that is untested in our population, even if it has FDA approval,” the organization said.
AMDA said it based its decision not to endorse the drug on the following arguments:
- The lack of evidence of benefit, along with the significant potential for dangerous side effects, is likely to have negative consequences for the six million people living with dementia in this country, along with their caregivers; and
- The high cost and need for sophisticated neuroimaging can be expected to widen inequitable care gaps.
The organization is advocating for a “coverage with evidence program,” where the Centers for Medicare & Medicaid Services can negotiate prices only when they are linked to “appropriate populations and actual evidence of efficacy.”
There may never be a single medication for the many types of dementia, AMDA added. In the meantime, the organization said it will advocate for public health campaigns to reduce modifiable risk factors such as vascular disease as well as legislation that supports effective caregiving and care models for dementia.