Effectiveness of Florbetapir PET Imaging in Changing Patient Management

Michael J. Pontecorvo, Andrew Siderowf, Bruno Dubois, P. Murali Doraiswamy, Giovanni B. Frisoni, Michael Grundman, Flavio Nobili, Carl H. Sadowsky, Stephen Salloway, Anupa K. Arora, Antoine Chevrette, Walter Deberdt, Grazia Dell'Agnello, Matthew Flitter, Nick Galante, Mark J. Lowrey, Ming Lu, Anne McGeehan, Michael D. Devous, Mark A. Mintun

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Aims: To evaluate the impact of amyloid PET imaging on diagnosis and patient management in a multicenter, randomized, controlled study. Methods: Physicians identified patients seeking a diagnosis for mild cognitive impairment or dementia, possibly due to Alzheimer disease (AD), and recorded a working diagnosis and a management plan. The patients underwent florbetapir PET scanning and were randomized to either immediate or delayed (1-year) feedback regarding amyloid status. At the 3-month visit, the physician updated the diagnosis and recorded a summary of the actual patient management since the post-scan visit. The study examined the impact of immediate versus delayed feedback on patient diagnosis/management at 3 and 12 months. Results: A total of 618 subjects were randomized (1:1) to immediate or delayed feedback arms, and 602 subjects completed the 3-month primary endpoint visit. A higher proportion of patients in the immediate feedback arm showed a change in diagnosis compared to the controls (32.6 vs. 6.4%; p = 0.0001). Similarly, a higher proportion of patients receiving immediate feedback had a change in management plan (68 vs. 55.5%; p < 0.002), mainly driven by changes in AD medication. Specifically, acetylcholinesterase inhibitors were prescribed to 67% of the amyloid-positive and 27% of the amyloid-negative subjects in the information group compared with 56 and 43%, respectively, in the control group (p < 0.0001). These between-group differences persisted until the 12-month visit. Conclusion: Knowledge of the amyloid status affects the diagnosis and alters patient management.

Original languageEnglish (US)
Pages (from-to)129-143
Number of pages15
JournalDementia and Geriatric Cognitive Disorders
DOIs
StateAccepted/In press - Aug 5 2017

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Amyloid
Alzheimer Disease
Physicians
florbetapir
Cholinesterase Inhibitors
Dementia
Control Groups

Keywords

  • Alzheimer disease
  • Amyloid
  • Diagnosis
  • Differential diagnosis
  • Florbetapir

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Cognitive Neuroscience
  • Psychiatry and Mental health

Cite this

Pontecorvo, M. J., Siderowf, A., Dubois, B., Doraiswamy, P. M., Frisoni, G. B., Grundman, M., ... Mintun, M. A. (Accepted/In press). Effectiveness of Florbetapir PET Imaging in Changing Patient Management. Dementia and Geriatric Cognitive Disorders, 129-143. https://doi.org/10.1159/000478007

Effectiveness of Florbetapir PET Imaging in Changing Patient Management. / Pontecorvo, Michael J.; Siderowf, Andrew; Dubois, Bruno; Doraiswamy, P. Murali; Frisoni, Giovanni B.; Grundman, Michael; Nobili, Flavio; Sadowsky, Carl H.; Salloway, Stephen; Arora, Anupa K.; Chevrette, Antoine; Deberdt, Walter; Dell'Agnello, Grazia; Flitter, Matthew; Galante, Nick; Lowrey, Mark J.; Lu, Ming; McGeehan, Anne; Devous, Michael D.; Mintun, Mark A.

In: Dementia and Geriatric Cognitive Disorders, 05.08.2017, p. 129-143.

Research output: Contribution to journalArticle

Pontecorvo, MJ, Siderowf, A, Dubois, B, Doraiswamy, PM, Frisoni, GB, Grundman, M, Nobili, F, Sadowsky, CH, Salloway, S, Arora, AK, Chevrette, A, Deberdt, W, Dell'Agnello, G, Flitter, M, Galante, N, Lowrey, MJ, Lu, M, McGeehan, A, Devous, MD & Mintun, MA 2017, 'Effectiveness of Florbetapir PET Imaging in Changing Patient Management', Dementia and Geriatric Cognitive Disorders, pp. 129-143. https://doi.org/10.1159/000478007
Pontecorvo MJ, Siderowf A, Dubois B, Doraiswamy PM, Frisoni GB, Grundman M et al. Effectiveness of Florbetapir PET Imaging in Changing Patient Management. Dementia and Geriatric Cognitive Disorders. 2017 Aug 5;129-143. https://doi.org/10.1159/000478007
Pontecorvo, Michael J. ; Siderowf, Andrew ; Dubois, Bruno ; Doraiswamy, P. Murali ; Frisoni, Giovanni B. ; Grundman, Michael ; Nobili, Flavio ; Sadowsky, Carl H. ; Salloway, Stephen ; Arora, Anupa K. ; Chevrette, Antoine ; Deberdt, Walter ; Dell'Agnello, Grazia ; Flitter, Matthew ; Galante, Nick ; Lowrey, Mark J. ; Lu, Ming ; McGeehan, Anne ; Devous, Michael D. ; Mintun, Mark A. / Effectiveness of Florbetapir PET Imaging in Changing Patient Management. In: Dementia and Geriatric Cognitive Disorders. 2017 ; pp. 129-143.
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AU - Pontecorvo, Michael J.

AU - Siderowf, Andrew

AU - Dubois, Bruno

AU - Doraiswamy, P. Murali

AU - Frisoni, Giovanni B.

AU - Grundman, Michael

AU - Nobili, Flavio

AU - Sadowsky, Carl H.

AU - Salloway, Stephen

AU - Arora, Anupa K.

AU - Chevrette, Antoine

AU - Deberdt, Walter

AU - Dell'Agnello, Grazia

AU - Flitter, Matthew

AU - Galante, Nick

AU - Lowrey, Mark J.

AU - Lu, Ming

AU - McGeehan, Anne

AU - Devous, Michael D.

AU - Mintun, Mark A.

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N2 - Aims: To evaluate the impact of amyloid PET imaging on diagnosis and patient management in a multicenter, randomized, controlled study. Methods: Physicians identified patients seeking a diagnosis for mild cognitive impairment or dementia, possibly due to Alzheimer disease (AD), and recorded a working diagnosis and a management plan. The patients underwent florbetapir PET scanning and were randomized to either immediate or delayed (1-year) feedback regarding amyloid status. At the 3-month visit, the physician updated the diagnosis and recorded a summary of the actual patient management since the post-scan visit. The study examined the impact of immediate versus delayed feedback on patient diagnosis/management at 3 and 12 months. Results: A total of 618 subjects were randomized (1:1) to immediate or delayed feedback arms, and 602 subjects completed the 3-month primary endpoint visit. A higher proportion of patients in the immediate feedback arm showed a change in diagnosis compared to the controls (32.6 vs. 6.4%; p = 0.0001). Similarly, a higher proportion of patients receiving immediate feedback had a change in management plan (68 vs. 55.5%; p < 0.002), mainly driven by changes in AD medication. Specifically, acetylcholinesterase inhibitors were prescribed to 67% of the amyloid-positive and 27% of the amyloid-negative subjects in the information group compared with 56 and 43%, respectively, in the control group (p < 0.0001). These between-group differences persisted until the 12-month visit. Conclusion: Knowledge of the amyloid status affects the diagnosis and alters patient management.

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KW - Differential diagnosis

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