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Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|December 25, 2025
PubMed
Summary
This summary is machine-generated.

Amyloid-related imaging abnormalities (ARIAs) are a risk for Alzheimer's patients on anti-amyloid therapy, especially those with the ApoE4 genotype. Most ARIAs are mild and resolve, but ARIA-H can persist, necessitating monitoring.

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Area of Science:

  • Neurology
  • Pharmacology
  • Radiology

Background:

  • Amyloid-related imaging abnormalities (ARIAs) are known complications of anti-amyloid therapies for Alzheimer's disease (AD).
  • ARIAs encompass ARIA-edema (ARIA-E) and ARIA-hemorrhage (ARIA-H), presenting asymptomatically or with mild symptoms.
  • Identifying risk factors like the ApoE4 genotype is crucial for managing AD patients on anti-amyloid treatments.

Purpose of the Study:

  • To analyze the incidence, characteristics, and risk factors of ARIAs in patients undergoing anti-amyloid antibody therapy.
  • To compare ARIA occurrences across different anti-amyloid agents (Aducanumab, Gantenerumab, Crenezumab).
  • To understand the clinical course and resolution patterns of ARIA-E and ARIA-H.

Main Methods:

  • Retrospective observational analysis of patient data from anti-amyloid antibody clinical trials.
  • Recorded demographic data, ApoE genotyping, cardiovascular risk factors, and ARIA events.
  • Classified ARIA events (ARIA-E, ARIA-H), documented symptoms, onset, resolution, and monitored progression via brain MRI.

Main Results:

  • ARIAs occurred in 9 of 52 patients (17.3%), with 15 events recorded across Aducanumab and Gantenerumab treatments; Crenezumab showed no events.
  • Most events were asymptomatic or mild, with ARIA-E resolving spontaneously (4-8 weeks) and ARIA-H persisting.
  • A strong correlation was observed between ARIA development and the ApoE4 genotype; events typically occurred between weeks 20-39.

Conclusions:

  • Patients with the ApoE4 genotype are at higher risk for developing ARIAs during anti-amyloid therapy.
  • ARIAs are generally manageable without treatment discontinuation, with distinct resolution patterns for ARIA-E and ARIA-H.
  • Regular MRI monitoring and individualized management are essential for optimizing anti-amyloid therapy outcomes in AD patients.