Radiology providers see opportunity on the horizon following the approval of Aduhelm, Biogen’s blockbuster new Alzheimer’s treatment, on Monday.
Screening patients for access to the drug will necessitate either a PET scan or lumbar puncture, experts noted. And individuals will also require a baseline MRI within one year before treatment and two more exams prior to subsequent infusions.
As cases of Alzheimer’s climb, so too will the number of individuals receiving Aduhelm, a controversial amyloid beta-directed antibody purported to attack the underlying cause of the disease. Drugmaker Biogen estimates more than 1.5 million patients will be eligible in the U.S., and instances of the disease are anticipated to double by 2050, up to 13 million.
Radiology providers are taking notice. Publicly traded imaging center operator Akumin sent an alert to investors Wednesday highlighting the “important implications.”
“Given that (a) patients seeking access to Aduhelm could be screened via PET scans; and (b) all patients receiving the treatment will require several MRIs, it is highly likely that industry players like Akumin will benefit from increased volumes for these modalities,” R. Jeffrey White, MBA, director of corporate development and investor relations, wrote June 9.
Following the U.S. Food and Drug Administration’s approval, fellow publicly traded imaging operator RadNet saw its stock jump 21%. Chief Financial Officer Mark Stolper could not pinpoint the source of such investor interest. But he said spectators could likely attribute the uptick to an anticipated increase in brain scans.
RadNet operates a network of nearly 350 outpatient imaging centers across states that cover more than 25% of the U.S. population. Theoretically, the company could serve some 500,000 patients eligible for Aduhelm, he noted.
“While there is much to continue to be worked out—such as reimbursement for these diagnostic tests by Medicare and the private health plans—this remains an exciting opportunity for RadNet and the rest of the diagnostic imaging industry offering advanced imaging,” Stolper told Radiology Business.
Akumin did not see the same bump in its stock, up 2% during the same period. But White said he sent the alert after a large trade of its shares—roughly 1 million, or 10 times the average daily volume—on Tuesday. The Plantation, Florida-based company operates 134 outpatient imaging centers across the U.S. and has excess capacity to absorb a substantial swell in demand.
“We are confident that we will be able to handle any increased PET and MRI volumes in our existing facilities from patients seeking treatment with Aduhelm, especially in the near term as any increased volume will take time to materialize,” White told Radiology Business. “We are going to be following these developments closely and expect that other industry participants will do the same.”
Imaging indications
Radiology Partners, another large California provider, is also paying close attention. Eric Rohren, MD, PhD, one of RPs physician leaders, was “surprised” at how little is being said about imaging and its incorporation into the workup for Aduhelm administration. He pointed to packaging inserts, which make several mentions. Patients must undergo MRIs before the seventh and 12th infusions of the drug. If radiographic severe ARIAs (amyloid-related imaging abnormalities) are observed, treatment may be continued with caution only after a clinical evaluation and a follow-up MRI demonstrates stabilization.
Warnings for the drug recommend “enhanced clinical vigilance” for ARIA after the first eight doses, particularly during titration. If a patient experiences symptoms suggestive of ARIA, the warnings noted, clinical evaluation should be performed, including MRI if indicated. Adverse reactions can include swelling, headaches, hemorrhaging or falls.
Rad Partners is currently gauging the availability of PET scanners across its practices and expertise to perform and interpret such imaging. On the MRI side, “it really comes down to a matter of capacity,” he added. Most practices have machines on hand. But many are already swamped working through backlogs. Rad Partners may need to explore adding capacity on weekends and evenings if demand meets expectations. He did not rule out expanding RP’s MR fleet down the line.
“If [Aduhelm] reaches a significant number of patients who are considered eligible, it has the potential to increase the demand for brain MRIs pretty substantially,” Rohren, who is associate chief medical officer for clinical research and education at El Segundo, California-based RP, told Radiology Business. “And of course, MRI scanners across the country generally are pretty busy already.”
Communication will be crucial, added Rohren, who is also chair of radiology at the Baylor College of Medicine in Houston. Radiologists will need to understand what they’re looking for on MRIs and how to report if such findings are present. The practice is putting together a plan to make sure its physicians are prepared.
Rohren anticipates that all practices will eventually be grappling with this issue and encouraged providers to seek out educational offerings and stay up to speed on the emerging imaging challenges.
“Radiology is going to be a major partner in the treatment of these patients. I’m excited to see where this all goes,” he said. “It could truly be a gamechanger.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.