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Tariot PN, Lopera F, Langbaum JB, Thomas RG, Hendrix S, Schneider LS, Rios-Romenets S, Giraldo M, Acosta N, Tobon C, Ramos C, Espinosa A, Cho W, Ward M, Clayton D, Friesenhahn M, Mackey H, Honigberg L, Sanabria Bohorquez S, Chen K, Walsh T, Langlois C, Reiman EM. The Alzheimer's Prevention Initiative Autosomal-Dominant Alzheimer's Disease Trial: A study of crenezumab versus placebo in preclinical PSEN1 E280A mutation carriers to evaluate efficacy and safety in the treatment of autosomal-dominant Alzheimer's disease, including a placebo-treated noncarrier cohort. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2018; 4:150-160. [PMID: 29955659 PMCID: PMC6021543 DOI: 10.1016/j.trci.2018.02.002] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Autosomal-dominant Alzheimer's disease (ADAD) represents a crucial population for identifying prevention strategies that might modify disease course for cognitively unimpaired individuals at high imminent risk for developing symptoms due to Alzheimer's disease (AD), that is, who have "preclinical" AD. Crenezumab is an antiamyloid monoclonal antibody that binds monomeric and aggregated forms of amyloid β, with highest affinity for oligomers; it is in development for early stages of sporadic AD and for ADAD. METHODS This is a prospective, randomized, double-blind, placebo-controlled phase 2 study of the efficacy of crenezumab versus placebo in asymptomatic PSEN1 E280A mutation carriers from family kindreds with ADAD in Colombia. Participants were randomized to receive either crenezumab or placebo for 260 weeks. The study was designed to enroll a planned total of 300 participants, including 200 preclinical mutation carriers (approximately 100 treatment, 100 placebo) and an additional control group of mutation noncarriers from the same family kindreds included to mask mutation carrier status (100 placebo only). The primary outcome is change in the Alzheimer's Prevention Initiative ADAD Composite Cognitive Test Score from baseline to week 260. Secondary outcomes include time to progression to mild cognitive impairment due to AD or dementia due to AD; changes in dementia severity, memory, and overall neurocognitive functioning; and changes in amyloid-positron emission tomography, fluorodeoxyglucose-positron emission tomography, magnetic resonance imaging volumes, and cerebrospinal fluid levels of β amyloid, tau, and p-tau. Safety and tolerability are assessed. RESULTS Two hundred fifty-two participants were enrolled between December 2013 and February 2017. DISCUSSION We describe the first large-scale, potentially label-enabling clinical trial of a preclinical treatment for ADAD. Results from this trial will inform on the efficacy of crenezumab for delaying onset of, slowing decline in, or preventing cognitive impairment in individuals with preclinical ADAD and will foster an improved understanding of AD biomarkers and their relationship to clinical outcomes.
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Affiliation(s)
| | - Francisco Lopera
- Grupo de Neurociencias, Universidad de Antioquia, SIU, Medellín, Colombia
| | | | - Ronald G. Thomas
- Department of Neurosciences, University of California San Diego School of Medicine, La Jolla, CA, USA
| | | | - Lon S. Schneider
- USC State of California Alzheimer's Disease Research and Clinical Center, Keck Medicine of USC, Los Angeles, CA, USA
| | | | - Margarita Giraldo
- Grupo de Neurociencias, Universidad de Antioquia, SIU, Medellín, Colombia
| | - Natalia Acosta
- Grupo de Neurociencias, Universidad de Antioquia, SIU, Medellín, Colombia
| | - Carlos Tobon
- Grupo de Neurociencias, Universidad de Antioquia, SIU, Medellín, Colombia
| | - Claudia Ramos
- Grupo de Neurociencias, Universidad de Antioquia, SIU, Medellín, Colombia
| | - Alejandro Espinosa
- Grupo de Neurociencias, Universidad de Antioquia, SIU, Medellín, Colombia
| | - William Cho
- Genentech, a Member of the Roche Group, South San Francisco, CA, USA
| | - Michael Ward
- Genentech, a Member of the Roche Group, South San Francisco, CA, USA
| | - David Clayton
- Genentech, a Member of the Roche Group, South San Francisco, CA, USA
| | | | - Howard Mackey
- Genentech, a Member of the Roche Group, South San Francisco, CA, USA
| | - Lee Honigberg
- Genentech, a Member of the Roche Group, South San Francisco, CA, USA
| | | | - Kewei Chen
- Banner Alzheimer's Institute, Phoenix, AZ, USA
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Abstract
Researchers have begun to characterize the subtle biological and cognitive processes that precede the clinical onset of Alzheimer disease (AD), and to set the stage for accelerated evaluation of experimental treatments to delay the onset, reduce the risk of, or completely prevent clinical decline. In this Review, we provide an overview of the experimental strategies, and brain imaging and cerebrospinal fluid biomarker measures that are used in early detection and tracking of AD, highlighting at-risk individuals who could be suitable for preclinical monitoring. We discuss how advances in the field have contributed to reconceptualization of AD as a sequence of biological changes that occur during progression from preclinical AD, to mild cognitive impairment and finally dementia, and we review recently proposed research criteria for preclinical AD. Advances in the study of preclinical AD have driven the recognition that efficacy of at least some AD therapies may depend on initiation of treatment before clinical manifestation of disease, leading to a new era of AD prevention research.
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