Forecasting the Prevalence of Alzheimer's Disease at Mild Cognitive Impairment and Mild Dementia Stages in France in 2022

BACKGROUND

Given the evolution of early diagnosis guidelines and future disease-modifying therapies, estimating the prevalence of Alzheimer's disease (AD) at early stages is key.

OBJECTIVE

To estimate the number of people living with mild cognitive impairment (MCI) due to AD and mild AD dementia in France in 2022 that could be eligible to future AD therapies.

METHODS

A step-by-step approach was defined based on disease stages definition and clinical practice. In line with AD guidelines, amyloid-positive profile is considered in our estimates to enhance the diagnosis accuracy of early stages of AD. Age-stratified prevalence from French cohort and international pooled analyses were identified to feed the different steps. To consider uncertainty around mean prevalence values, low and high scenarii based on the lower and upper bounds of the 95% confidence interval were conducted.

RESULTS

We estimated that 2.5 (low scenario: 1.7 - high scenario: 3.6) million people suffer from mild cognitive impairment in France in 2022 among whom 1.65 (low: 1.5 - high: 1.8) million people meet the criteria for mild cognitive impairment due to AD i.e., with amyloid positive profile. The expected number of clinical AD dementia is estimated at 925,886 people. Among those, 379,278 people suffer from mild AD dementia based on clinical diagnosis, including 311,043 (low: 289,174 - high: 328,332) cases with amyloid positive profile.

CONCLUSION

MCI due to AD, and mild dementia stages are potentially of high prevalence. Population-based studies are needed to confirm those estimates.

Overall and patient-level comparative effectiveness of dimethyl fumarate and fingolimod: A precision medicine application to the Observatoire Français de la Sclérose en Plaques registry

Background

Comparing real-world effectiveness and tolerability of therapies for relapsing-remitting multiple sclerosis is increasingly important, though average treatment effects fail to capture possible treatment effect heterogeneity. With the clinical course of the disease being highly heterogeneous across patients, precision medicine methods enable treatment response heterogeneity investigations.

Objective

To compare real-world effectiveness and discontinuation profiles between dimethyl fumarate and fingolimod while investigating treatment effect heterogeneity with precision medicine methods.

Methods

Adults initiating dimethyl fumarate or fingolimod as a second-line therapy were selected from a French registry. The primary outcome was annualized relapse rate at 12 months. Seven secondary outcomes relative to discontinuation and disease progression were considered. A precision medicine framework was used to characterize treatment effect heterogeneity.

Results

Annualized relapse rates at 12 months were similar for dimethyl fumarate and fingolimod. The odd of treatment persistence was 47% lower for patients treated with dimethyl fumarate relative to those treated with fingolimod (odds ratio: 0.53, 95% confidence interval: 0.39, 0.70). None of the five precision medicine scoring approaches identified treatment heterogeneity.

Conclusion

These findings substantiated the similar effectiveness and different discontinuation profiles for dimethyl fumarate and fingolimod as a second-line therapy for relapsing-remitting multiple sclerosis, with no significant effect heterogeneity observed.