Neurology: A meta-analysis of the incidence of amyloid-related imaging abnormalities in patients with Alzheimer's disease with anti-β-amyloid immunotherapy

Alzheimer's disease (AD) is a globally prevalent neurodegenerative disease that causes gradual, irreversible destruction of neurons and leads to loss of cognitive function and memory
.
Over time, the patient progresses to severe dementia and loss of independence, eventually dying
.
Unfortunately, clinical treatment options to date have been very limited, and some previously approved drugs, including acetylcholinesterase inhibitors and N-methyl-D-aspartate antagonists, only provide symptom improvement rather than radically improve disease progression
.
However, on June 7, 2021, the U.
S.
Food and Drug Administration (FDA) approved aducanumab for the accelerated approval pathway; This is the first new drug
for the treatment of AD since 2003.
Amyloidosis-associated imaging abnormalities (ARIA) vasogenic oedema and/or colonic effusion (E) refers to MR signaling changes considered representative of vasogenic oedema and excessive fluid in the pia mater, manifested by increased FLAIR signal abnormalities with no imaging features indicating other pathologies such as ischaemia or tumor
.
ARIA hemorrhage (H) refers to alterations in MR signaling attributable to microbleeds and hemosiderosis that are detected on gradient echo/T2*weighted sequences and are thought to represent blood degradation products
.

Recently, a study published in Neurology counted the incidence of ARIA in anti-Aβ immunotherapy clinical trials, compared the incidence of different drugs and their clinical characteristics, and explored the possible predisposing factors
of ARIA.

The PubMed and Embase databases searched the database for clinical trials
of anti-Aβ immunotherapy published on or before January 12, 2022.
Select phase 2 or 3 randomized controlled trials that report detailed data
sufficient to assess the incidence of ARIA.
Using the DerSimonian-Liard random-effects model, the combined incidence
of ARIA and subgroup analyses was calculated based on drug and ApoE-4 carrier status.
Calculate the proportion
of symptomatic ARIA cases.

The overall incidence of ARIA-E and ARIA-H was 6.
5% and 7.
8%, respectively, with a combined incidence of asymptomatic ARIA of 80.
4%.

The incidence of ARIA-E and ARIA-H in patients treated with aducanumab was 30.
7% and 30.
0%,
respectively, compared with other agents.

Source: Jeong SY, Suh CH, Shim WH, Lim JS, Lee JH, Kim SJ.
Incidence of Amyloid-Related Imaging Abnormalities in Patients With Alzheimer Disease Treated With Anti-β-amyloid Immunotherapy: A Meta-analysis [published online ahead of print, 2022 Aug 29].
Neurology.
2022; 10.
1212/WNL.
0000000000201019.
doi:10.
1212/WNL.
0000000000201019