Neurology infusion-centre capacity: the deliverability constraint that will shape uptake

What the deliverability constraint is

Anti-amyloid antibody therapy for Alzheimer's disease requires:

• Infusion-centre capacity (every 2 or every 4 weeks, depending on the asset)
• ARIA monitoring infrastructure (regular MRI access for the first months of therapy)
• Specialist follow-up (neurology or memory-clinic visits at protocol-defined intervals)
• Patient and caregiver coordination across the appointment burden

The combination is more demanding than the typical chronic neurology therapy regimen. The existing infusion-centre infrastructure in most major markets was built for oncology, immunology and adjacent indications, not for population-scale Alzheimer's therapy delivery.

The geography of the gap

Capacity assessment work across major markets shows substantial variation:

• Major academic medical centres typically have infusion capacity to absorb local Alzheimer's demand, with caveats around MRI capacity for ARIA monitoring
• Regional and community settings vary widely. Some markets have well-distributed neurology infusion infrastructure; others have substantial geographic gaps
• The MRI access constraint is often more binding than the infusion-chair constraint. ARIA monitoring requires more frequent and more-protocol-specified MRI access than most health systems' MRI scheduling can accommodate at the eligible-population scale
• The specialist follow-up constraint compounds in markets where neurology specialist supply is already constrained

What this means for commercial planning

For sponsors of anti-amyloid antibody therapy and adjacent infusion-route neurology assets:

1. The launch operating model has to engage with capacity, not assume it. Infusion-centre support, ARIA-monitoring workflow tooling, and specialist-network development are commercial inputs at launch
2. The geographic uptake curve will be uneven. Markets and regions with stronger infusion infrastructure will see faster uptake; markets without will lag, and the lag will not close quickly
3. Capacity-building investment is leveraged. Sponsors that invest in capacity expansion (infrastructure grants, workflow tools, specialist-network development) shorten their own commercial timeline

The deliverability constraint is going to be the principal commercial conversation in anti-amyloid therapy for at least the next five years, and it generalises to other infusion-route neurology assets entering the market.

What we are watching

• Capacity-assessment work across markets and the rate of capacity expansion
• Subcutaneous-route formulation development for the anti-amyloid class and adjacent assets, which would substantially relax the deliverability constraint
• ARIA-monitoring workflow innovation (lower-frequency MRI protocols, alternative imaging modalities, plasma biomarker monitoring) and the implications for the operational burden