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Dantas JM, Mutarelli A, Navalha DDP, Dagostin CS, Romeiro PHCL, Felix N, Nogueira A, Batista S, Teixeira L, Caramelli P. Efficacy of anti-amyloid-ß monoclonal antibody therapy in early Alzheimer's disease: a systematic review and meta-analysis. Neurol Sci 2024; 45:2461-2469. [PMID: 37978096 DOI: 10.1007/s10072-023-07194-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Studies targeting amyloid-ß in patients with Alzheimer's disease (AD) have conflicting results and early initiation of therapy may yield better outcomes. METHODS We systematically searched PubMed, Embase, Cochrane Library, and Clinicaltrials.gov for randomized trials comparing monoclonal antibodies (mAbs) with placebo in MCI or mild dementia due to AD. RESULTS Nineteen studies comprising 15,275 patients were included. In patients with early AD, mAbs reduced the rate of decline, in both the Clinical Dementia Rating Scale, the sum of boxes (CDR-SB; MD -0.30; 95% CI -0.42,-0.19; p < 0.01), and the Alzheimer's Disease Assessment Scale, cognitive subscore (ADAS-cog; SMD -0.80; 95% CI -10.25,-0.35; p < 0.01). The results were similar between clinical stages for CDR-SB (MCI, MD -0.19; 95% CI -0.35,-0.03; p = 0.02; mild dementia, MD -0.45; 95% CI -0.65,-0.25; p < 0.01; subgroup differences, p = 0.13), as well as for ADAS-Cog (MCI, SMD -0.83; 95% CI -1.49,-0.17; p = 0.01; mild dementia, SMD -0.69; 95% CI -1.32 to -0.05; p = 0.03; subgroup differences, p = 0.47). The risk of amyloid-related imaging abnormalities (ARIA) was significantly higher in patients taking mAbs, including ARIA-edema (RR 7.7; 95% CI 4.60 to 13.00; p < 0.01), ARIA-hemorrhage (RR 1.8; 95% CI 1.22 to 2.59; p < 0.01), and symptomatic or serious ARIA (RR 14.1; 95% CI 7.30 to 27.14; p < 0.01). CONCLUSION Anti-amyloid-ß mAbs attenuate cognitive and functional decline compared with placebo in early AD; whether the magnitude of this effect is clinically important remains uncertain, especially relative to the safety profile of these medications. Starting immunotherapy in patients with MCI was not significantly different than starting in the mild dementia stage. PROSPERO REGISTRY CRD42023430698.
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Affiliation(s)
- Julyana M Dantas
- Universidade Federal do Rio Grande do Norte, Av. Nilo Peçanha, 620 - Petrópolis, Natal, RN, 59012-300, Brazil.
| | | | | | | | | | - Nicole Felix
- Universidade Federal de Campina Grande, Campina Grande, Brazil
| | - Alleh Nogueira
- Escola Bahiana de Medicina e Saúde Pública, Salvador, Brazil
| | - Sávio Batista
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Paulo Caramelli
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Heidebrink JL, Paulson HL. Lessons Learned from Approval of Aducanumab for Alzheimer's Disease. Annu Rev Med 2024; 75:99-111. [PMID: 38285515 PMCID: PMC10926277 DOI: 10.1146/annurev-med-051022-043645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
When the US Food and Drug Administration used the accelerated approval process to authorize the use of the antiamyloid drug aducanumab to treat Alzheimer's disease (AD), many people hoped this signaled a new era of disease-modifying treatment. But 2 years later, aducanumab's failure to launch provides a cautionary tale about the complexities of dementia and the need for a thorough and transparent review of the role that regulatory agencies and various stakeholders play in approving AD drugs. We highlight the events leading to aducanumab's controversial approval and discuss some of the key lessons learned from the drug's failure to deliver the hoped-for benefits. These lessons include the inherent limitations of antiamyloid strategies for a complex disease in which amyloid is only one of several pathological processes, the need for clinical trials that better reflect the diversity of communities affected by AD, the potential pitfalls of futility analyses in clinical trials, the need for greater transparency and other modifications to the approval process, and the dementia field's unreadiness to move from the highly controlled environment of clinical trials to the widespread and chronic use of resource-intensive, disease-modifying drugs in real-world treatment scenarios. People with dementia desperately need effective therapies. We hope that the aducanumab story will inspire changes to the approval process-changes that restore public trust and improve future efforts to deliver disease-modifying therapies to the clinic.
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Affiliation(s)
- Judith L Heidebrink
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA; ,
- Michigan Alzheimer's Disease Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Henry L Paulson
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA; ,
- Michigan Alzheimer's Disease Center, University of Michigan, Ann Arbor, Michigan, USA
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, Michigan, USA
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Goo C, Morden F, Wong K, Aquino S, Kawamura J, Rubel V, Masca S, Gorenflo R, Carrazana E, Liow K. Familiarity and Perceptions of Aducanumab in Caregivers of Hawaii Alzheimer's Disease Patients: Results of a Telephone Survey. Cureus 2023; 15:e50001. [PMID: 38186481 PMCID: PMC10767469 DOI: 10.7759/cureus.50001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/09/2024] Open
Abstract
AIM To identify current perceptions of aducanumab among patients with Alzheimer's disease (AD) and their caregivers. METHODS A total of 352 caregivers of AD patients seen at Hawaii's largest multidisciplinary neuroscience center between January 01, 2019, and June 21, 2021, were surveyed by telephone to understand patient and caregiver knowledge, familiarity, and hesitancy toward aducanumab. RESULTS Thirty-seven percent of caregivers were familiar with aducanumab. Caregivers who were spouses of their respective patients with AD (p=0.0023) had increased odds of familiarity. Additional predictors of aducanumab familiarity included patients with higher mini-mental state examination scores (p=0.0076) and those who received mental stimulation (p=0.007). Conversely, caregivers who identified as native Hawaiian and other Pacific Islanders (NHPI) (p=0.044) or the patient's child (p=0.010) were predictors of decreased familiarity. Only 33% of caregivers familiar with aducanumab believed it to be safe and 56% reported "side effects" as their top concern. Thirty percent of caregivers were moderately ready or very ready to use aducanumab if given the opportunity. CONCLUSION Most caregivers of Hawaii AD patients were unfamiliar with aducanumab. Furthermore, those familiar were hesitant to trial the medication. Improved education and awareness of AD therapies are important, so families and caregivers of AD patients can make more informed decisions regarding AD treatment.
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Affiliation(s)
- Connor Goo
- Brain Research, Innovation & Translation Laboratory, Hawaii Pacific Neuroscience, Honolulu, USA
- Neurology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, USA
| | - Frances Morden
- Brain Research, Innovation & Translation Laboratory, Hawaii Pacific Neuroscience, Honolulu, USA
- Neurology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, USA
| | - Kasen Wong
- Brain Research, Innovation & Translation Laboratory, Hawaii Pacific Neuroscience, Honolulu, USA
- Neurology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, USA
| | - Sarvia Aquino
- Brain Research, Innovation & Translation Laboratory, Hawaii Pacific Neuroscience, Honolulu, USA
| | - Jaron Kawamura
- Brain Research, Innovation & Translation Laboratory, Hawaii Pacific Neuroscience, Honolulu, USA
| | - Vanessa Rubel
- Brain Research, Innovation & Translation Laboratory, Hawaii Pacific Neuroscience, Honolulu, USA
| | - Samantha Masca
- Brain Research, Innovation & Translation Laboratory, Hawaii Pacific Neuroscience, Honolulu, USA
| | - Rachel Gorenflo
- Brain Research, Innovation & Translation Laboratory, Hawaii Pacific Neuroscience, Honolulu, USA
| | - Enrique Carrazana
- Brain Research, Innovation & Translation Laboratory, Hawaii Pacific Neuroscience, Honolulu, USA
- Neurology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, USA
| | - Kore Liow
- Brain Research, Innovation & Translation Laboratory, Hawaii Pacific Neuroscience, Honolulu, USA
- Neurology, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, USA
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Daly TP. Informing consent to antibodies in Alzheimer's disease. BMJ 2023; 383:2350. [PMID: 37821123 DOI: 10.1136/bmj.p2350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
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Xu C, Zhao L, Dong C. The performance of plasma phosphorylated tau231 in detecting Alzheimer's disease: A systematic review with meta-analysis. Eur J Neurosci 2023; 58:3132-3149. [PMID: 37501373 DOI: 10.1111/ejn.16085] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/29/2023]
Abstract
Cerebrospinal fluid (CSF) phosphorylated tau231 (P-tau231) is associated with neuropathological outcomes of Alzheimer's disease (AD). The invasive access of cerebrospinal fluid has greatly stimulated interest in the identification of blood-based P-tau231, and the recent advent of single-molecule array assay for the quantification of plasma P-tau231 may provide a turning point to evaluate the usefulness of P-tau231 as an AD-related biomarker. Yet, in the plasma P-tau231 literature, findings with regard to its diagnostic utility have been inconsistent, and thus, we aimed to statistically investigate the potential of plasma P-tau231 in the context of AD via meta-analysis. Publications on plasma P-tau231 were systematically retrieved from PubMed, EMBASE, the Cochrane library and Web of Science databases. A total of 10 studies covering 2007 participants were included, and we conducted random-effect or fixed-effect meta-analysis, sensitivity analysis and publication bias analysis using the STATA SE 14.0 software. According to our quantitative integration, plasma P-tau231 increased from cognitively unimpaired (CU) populations to mild cognitive impairment to AD and showed significant changes in pairwise comparisons of AD, mild cognitive impairment and CU. Plasma P-tau231 level was significantly higher in CU controls with positive amyloid-β (Aβ) status compared with Aβ-negative CU group. Additionally, the excellent diagnostic accuracy of plasma P-tau231 for asymptomatic Aβ pathology was verified by the pooled value of area under the receiver operating characteristic curves (standard mean difference [95% confidence interval]: .75 [.69, .81], P < 0.00001). Overall, the increased plasma P-tau231 concentrations were found in relation to the early development and progression of AD.
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Affiliation(s)
- Chang Xu
- Department of Neurology, the First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Li Zhao
- Department of Neurology, the First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Chunbo Dong
- Department of Neurology, the First Affiliated Hospital, Dalian Medical University, Dalian, China
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Wolff JL, Peereboom D, Hay N, Polsky D, Ornstein KA, Boyd CM, Samus QM. Advancing the Research-to-Policy and Practice Pipeline in Aging and Dementia Care. THE PUBLIC POLICY AND AGING REPORT 2023; 33:22-28. [PMID: 36873958 PMCID: PMC9976701 DOI: 10.1093/ppar/prac037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Indexed: 06/18/2023]
Affiliation(s)
- Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Danielle Peereboom
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Nadia Hay
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel Polsky
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katherine A Ornstein
- Center for Equity in Aging, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Quincy M Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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7
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Borah K, Bora K, Mallik S, Zhao Z. Potential Therapeutic Agents on Alzheimer's Disease through Molecular Docking and Molecular Dynamics Simulation Study of Plant-Based Compounds. Chem Biodivers 2023; 20:e202200684. [PMID: 36480442 DOI: 10.1002/cbdv.202200684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/13/2022]
Abstract
Globally Alzheimer's disease (AD) is a highly complex, heterogeneous, and multifactorial neurological disease. AD is categorized clinically through a steady loss in memory and progressive decline of cognitive function. So far, there is no effective cure is available for the treatment of AD. Here, we identified Plant-based compounds (PBCs) from seven therapeutic plants through pharmacophore and pharmacokinetics approaches. Subsequently, we retrieved 65 AD associated proteins by Text Mining approach .We observed the interactions between 39 PBCs with 65 AD-associated targets by using molecular docking. Further, we carried out Molecular dynamics simulation analysis to predict the steady binding of top drug-target complexes. The entire MD simulation results analysis was evidence that seven drug-target complexes consistently interacted during the in silico experiment. The top complexes were the target CHLE interacted with 2 PBCs (Pseudojujubogenin and Anahygrine), target VDAC1 interacted with Withanolide R, target THOP1 interacted with Withaolide R, target AOFB interacted with 2 PBCs (Nardostachysin and Viscosalactone B), and target ACHE interacted with the drug (12-Deoxywithastramonolide). These PBCs have stably and flexibly interacted at the protein's active site region. Our results suggest that these PBCs and targets are potential therapeutic candidates for molecular development in AD.
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Affiliation(s)
- Kasmika Borah
- Cotton University, Computer Science and IT Department, Hem Baruah Rd, Pan Bazaar, Guwahati, Assam, 781001, India
| | - Kangkana Bora
- Cotton University, Computer Science and IT Department, Hem Baruah Rd, Pan Bazaar, Guwahati, Assam, 781001, India
| | - Saurav Mallik
- Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA.,Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA 02115, USA
| | - Zhongming Zhao
- Center for Precision Health, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
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DiStefano MJ, Alexander GC, Anderson GF. Reply to: The informed majority could help make research into Alzheimer's disease fairer and more efficient. J Am Geriatr Soc 2022; 70:1883-1885. [PMID: 35343584 DOI: 10.1111/jgs.17757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Michael J DiStefano
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
| | - G Caleb Alexander
- Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Gerard F Anderson
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
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9
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Daly T. The informed majority could help make research into Alzheimer's disease fairer and more efficient. J Am Geriatr Soc 2022; 70:1882-1883. [PMID: 35343591 DOI: 10.1111/jgs.17756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Timothy Daly
- Science Norms Democracy, UMR 8011, Sorbonne Université, Paris, France
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