Implementation of Lecanemab for Alzheimer's Disease Within the Veterans Health Administration: Facilitators and Barriers

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BACKGROUND: Several amyloid targeting therapies have been approved for Alzheimer's disease (AD), including lecanemab (Leqembi). However, real-world implementation of these drugs has uncovered significant challenges. METHODS: We conducted a national cross-sectional survey of healthcare professionals from multiple disciplines participating in the Veteran's Health Administration (VHA) AD Therapeutics Community of Practice. The goal of the survey was to identify facilitators and barriers to the implementation of lecanemab within their respective medical centers. The web-based survey was open from September 17, 2024 to October 4, 2024. RESULTS: Surveys were sent to 128 healthcare team members with 44 responders (34% response rate). Of the responders, the majority were physicians (59%, n = 26) or pharmacists (25%, n = 11). In all, 41% indicated that they were currently administering lecanemab (n = 18), 32% were planning on administering lecanemab (n = 14), 20% were unsure if they would be administering lecanemab (n = 9), and 7% did not plan on offering the medication (n = 3). The five most common facilitators to implementation of lecanemab included pharmacist support (57%, n = 25), infusion center access and support (57%, n = 25), having a program champion (43%, n = 19), collaboration with other VHA medical centers implementing lecanemab (43%, n = 19), and access to advanced imaging such as amyloid positron emission tomography (PET) scans (43%, n = 19). The most common barrier to implementation of lecanemab identified by 45% of participants (n = 20) was lack of staff to monitor treatment. Other common barriers included challenges with stakeholder engagement (27%, n = 12), issues with identifying patients who qualify for lecanemab (27%, n = 12), lack of access to advanced imaging (25%, n = 11), and lack of neuroradiology support (23%, n = 10). CONCLUSIONS: Attention to identified facilitators and barriers may be helpful for facilities implementing amyloid targeting therapy for AD.

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