Initial Experiences with Amyloid-Related Imaging Abnormalities in Patients Receiving Aducanumab Following Accelerated...

Area of Science:

• Neurology
• Immunotherapy
• Alzheimer's Disease Research

Background:

• Aducanumab is the first FDA-approved immunotherapy targeting amyloid plaques in Alzheimer's disease.
• Real-world data on managing amyloid-related imaging abnormalities (ARIA), a key side effect, is limited.
• ARIA necessitates vigilant monitoring via magnetic resonance imaging.

Purpose of the Study:

• To report clinical experiences in managing ARIA in patients treated with aducanumab.
• To evaluate the effectiveness of the Appropriate Use Recommendations in guiding aducanumab therapy and ARIA management.
• To assess the incidence and severity of ARIA in a real-world clinical setting.

Main Methods:

• Retrospective analysis of patients receiving aducanumab at Butler Hospital Memory and Aging Program.
• Adherence to Appropriate Use Recommendations for patient selection, ARIA detection, and management.
• Monitoring of ARIA incidence, characteristics, and treatment modifications.

Main Results:

• Amyloid-related imaging abnormalities (ARIA-E) occurred in 6 of 24 patients, all of whom were APOE-ε4 carriers.
• Management strategies included treatment discontinuation (4 cases), temporary holds (1 case), and continuation (1 case).
• No hospitalizations or high-dose corticosteroid use were required; anticoagulated patients were excluded, and no macrohemorrhages occurred.

Conclusions:

• The Appropriate Use Recommendations provide a practical framework for managing aducanumab therapy and ARIA.
• Measured approaches to ARIA management are effective in a real-world clinical setting.
• Close surveillance and adherence to guidelines are crucial for safe aducanumab treatment.