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Competing Interests: N.J.B. and J.H.P. are employees of Novo Nordisk. M.S. is an employee of IQVIA. L.J. or his institution has received grants or contracts from Innovative Health Initiative (European Commission), Vinnova (Swedish Innovation Agency), the Swedish Research Council for Health, Working Life and Welfare, Novo Nordisk and Eli Lilly. L.J. has received royalties or licenses from the European Health Economics AB and consulting fees from H. Lundbeck. L.J. has received support for attending meetings and/or travel from BioArctic AB and has held a leadership or fiduciary role (paid or unpaid) in boards, societies, committees or advocacy groups for the Institute of Health Economics. A.S. declares no conflicts of interest.

The advancement of disease-modifying treatments (DMTs) for Alzheimer's disease (AD), along with the approval of three amyloid-targeting therapies in the US and several other countries, represents a significant development in the treatment landscape, offering new hope for addressing this once untreatable chronic progressive disease. However, significant challenges persist that could impede the successful integration of this class of drugs into clinical practice. These challenges include determining patient eligibility, appropriate use of diagnostic tools and genetic testing in patient care pathways, effective detection and monitoring of side effects, and improving the healthcare system's readiness by engaging both primary care and dementia specialists. Additionally, there are logistical concerns related to infrastructure, as well as cost-effectiveness and reimbursement issues. This article brings together insights from a diverse group of international researchers and dementia experts and outlines the potential challenges and opportunities, urging all stakeholders to prepare for the introduction of DMTs. We emphasize the need to develop appropriate use criteria, including patient characteristics, specifically for the European healthcare system, to ensure that treatments are administered to the most suitable patients. It is crucial to improve the skills and knowledge of physicians to accurately interpret biomarker results, share decision-making with patients, recognize treatment-related side effects, and monitor long-term treatment. We advocate for investment in patient registries and unbiased follow-up studies to better understand treatment effectiveness, evaluate treatment-related side effects, and optimize long-term treatment. Utilizing amyloid-targeting therapies as a starting point for combination therapies should also be a priority., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Bengt Winblad reports financial support was provided by Old Servants Foundation (Gamla Tjänarinnors stiftelse). Christoph Hock reports a relationship with Neurimmune AG that includes: employment. Lars Lannfelt reports a relationship with BioArctic AB that includes: employment. John R Sims reports a relationship with Eli Lilly and Company that includes: employment. Jose Luis Molinuevo reports a relationship with H Lundbeck AB that includes: employment. Philip Scheltens reports a relationship with EQT group that includes: employment. Norbert Zilka reports a relationship with Axon Neuroscience SE that includes: employment. Martin Tolar reports a relationship with Alzheon Inc that includes: employment. Peter Johannsen reports a relationship with Novo Nordisk that includes: employment. Kaj Blennow has served as a consultant and at advisory boards for Abbvie, AC Immune, ALZPath, AriBio, BioArctic, Biogen, Eisai, Lilly, Moleac Pte. Ltd, Neurimmune, Novartis, Ono Pharma, Prothena, Roche Diagnostics, Sanofi and Siemens Healthineers; has served at data monitoring committees for Julius Clinical and Novartis; has given lectures, produced educational materials and participated in educational programs for AC Immune, Biogen, Celdara Medical, Eisai and Roche Diagnostics; and is a co-founder of Brain Biomarker Solutions in Gothenburg AB (BBS), which is a part of the GU Ventures Incubator Program, outside the work presented in this paper. Bengt Winblad is member of the SAB for Axon Neuroscience, AlzeCure, Alzinova, Artery Therapeutics, CoVitality. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Masson SAS.)

Introduction: Informal care estimates for use in health-economic models are lacking. We aimed to estimate the association between informal care time and dementia symptoms across Europe., Methods: A secondary analysis was performed on 13,529 observations in 5,369 persons from 9 European pooled cohort or trial studies in community-dwelling persons with dementia. A mixed regression model was fitted to time spent on instrumental or basic activities of daily living using disease severity and demographic characteristics., Results: Daily informal care time was 0.5 hours higher in moderate compared to mild and 1.3h higher in severe compared to mild cognitive impairment. Likewise, this was 1.2h and 2.7h for functional disability and 0.3h and 0.6h for behavioral symptoms in the same directions., Discussion: Estimates can be used in both single- and multi-domain health-economic models for dementia in European settings., Competing Interests: Declaration of competing interest AS No conflict of interest. BW – no conflict of interest. CB received outside this study research grants from ZonMw, Alzheimer Nederland/Dutch Alzheimer Society and Gieskes Strijbis fund. He is board member of the Dutch Young-onset Dementia Knowledge Center and member of the IPA YOD shared interest forum and member INTERDEM and its YOD Taskforce (all unpaid). CGP: No conflict of interest (IQVIA did not give any authorization or funding for this work – as shared data set was not its property and as it was used for research CGP led before integrating IQVIA). GS have participated, outside this study, at advisory boards for Eisai and Roche, regarding monoclonal antibody drugs for the treatment of Alzheimer's disease. LF – received research grants unrelated to this work from Hoffmann-LaRoche. Received case honoraria for clinical trials paid to the institution from Axon Neuroscience, Anavex, Alector, Boehringer Ingelheim, Eisai, Hummingbird, NovoNordisk, Noselab; Consulting fees unrelated to this work from Biogen, BioVie, Eisai, Eli Lilly, FOMF, Araclon/Grifols, Janssen Cilag, Medical Tribune, Medfora, Neurimmune, Noselab, NovoNordisk, Roche, TauRX, Schwabe, StreamUp; Honoraria for Clinical study committees from Avanir/Otsuka, PharmatrophiX, Charité Berlin, Neuroscios, Vivoryon. LJ received research grants unrelated to this work from Vinnova, Innovative Health Initiative, Forte and Novo Nordisk A/S. Consulting fees unrelated to this work from H. Lundbeck A/S, Janssen, Eli Lilly Inc, and license fees for the RUD instrument. LS: has no competing interest related to the topic of this paper. OR: No potential conflict of interest to declare. RH received outside this study consulting fees in the past 36 months from Lilly Nederland and from the Institute for Medical Technology Assessment (paid to institution). RK received outside this study research grants from ZonMw, Dutch Alzheimer Society and Gieskes Strijbis fund. He is board member of the International Psychogeriatric Association, member of the IPA YOD shared interest forum and member INTERDEM and its YOD Taskforce and taskforce palliative care (all unpaid). SH – no conflict of interest. YP has no conflict of interest., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Background: The long-term real-world effect of immunotherapy (IO) is uncertain in metastatic nonsmall cell lung cancer (mNSCLC). This retrospective observational study aimed to describe treatment patterns following the introduction of IO, estimate real-world treatment effects of IO compared to standard of care, and evaluate the impact of introduction of IO on a real-world population, based on a large dataset of over 10 000 patients with several years of follow-up., Methods: Data from routine care of lung cancer patients were extracted from Flatiron Health including those who received either IO or platinum-based doublet chemotherapy (PBDC) in the first line (1L), or either IO or chemotherapy (CT) in the second line (2L). Real-world overall survival (rwOS) and real-world time to next therapy (rwTTNT) were estimated using Cox regression. Flexible parametric models, relaxing proportional hazard assumptions, were used to evaluate long-term IO effects., Results: After 1:1 nearest neighbor matching among 16 754 1L and 6548 2L patients, the hazard ratio (HR) was 0.942 (95% CI, 0.902-0.984) in 1L and 0.853 (95% CI, 0.795-0.915) in 2L. Adjusting for crossover effects, HR was 0.887 in 1L and 0.775 in 2L. Over the 7-year follow-up, the mean rwOS benefit was 3.2 months for 1L and 2.7 months for 2L. IO significantly delayed rwTTNT in both 1L and 2L. The IO effects increased and persisted over time, with uncertainty in the time-varying HR estimate., Conclusion: IO improves survival in patients with mNSCLC, though the effect size is smaller than in trials and long-term survival estimates are uncertain., (© 2025 The Author(s). Thoracic Cancer published by John Wiley & Sons Australia, Ltd.)