Robust findings on aducanumab’s effect in mild Alzheimer’s

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AlzheimersWEBTreatment with  monthly infusions of aducanumab in subjects with mild Alzheimer’s disease  reduced virtually all toxic amyloid plaques, accompanied by a dose-dependent slowing of clinical decline, showed the interim results from a major clinical trial.

It is a breakthrough that left scientists “trying not to get too excited” and larger trials are now under way, reports The Independent.

Researchers scanned the brains of people with the degenerative condition as they were given doses of the drug, which is based on an immune cell taken from the blood of elderly people aged up to 100 who showed no signs of the disease. After a year, virtually all the toxic “amyloid plaques” that build up in Alzheimer’s patients appeared to have gone from the brains of those given the highest doses of the antibody.

The report says the scientists also said the patients showed signs that the rate of their cognitive decline had slowed. The findings of the trial suggest the plaques are at least part of the cause of the disease – not simply a by-product. And, if the results are confirmed in larger clinical trials already under way around the world, one expert said it could be a “game-changer” for efforts to prevent Alzheimer’s.

One of the researchers, Professor Roger Nitsch, of Zurich University, described what they found when they scanned the brains of patients given either a placebo or three different doses of the antibody, called aducanumab. “One year later, the images of the placebo group are basically unchanged. In the three doses groups, a very clear reduction in amyloid plaques is shown – the higher the dose, the larger the degree of reduction,” he said. “In the 10mg dose group, after one year you can see no red on the image, meaning the amyloid has almost completely disappeared. Compared to other studies published in the past, the effect size of this drug is unprecedented.”

Commenting on the research, Professor Eric Reiman, of Arizona University, writes: “If these preliminary cognitive findings are confirmed in larger and more-definitive clinical trials, which are now under way, it would provide a shot in the arm in the fight against Alzheimer’s disease.

“But although the authors’ additional cognitive findings are encouraging, they are not definitive. It would be prudent to withhold judgement about aducanumab’s cognitive benefit until results from the larger trials are in.”

But he added: “Confirmation that an anti-amyloid plaque treatment slows cognitive decline would be a game-changer for how we understand, treat and prevent Alzheimer’s disease. Now is the time to find out.”

The report says the study, led by scientists at pharmaceutical companies Biogen and Neurimmune, sparked major interest from experts in the field.

Dr Tara Spires-Jones, interim director of Edinburgh University’s Centre for Cognitive and Neural Systems, said the research showed the antibody “robustly reduced amyloid pathology in a small group of people in very early stages of the disease”.

“I am cautiously optimistic about this treatment, but trying not to get too excited because many drugs make it through this early stage of testing then go on to fail in larger trials,” she said.

And Dr James Pickett, head of research at the Alzheimer’s Society, said: “These results are the most detailed and promising that we’ve seen for a drug that aims to modify the underlying causes of Alzheimer’s disease.

“The study showed that the drug was first able to remove clumps of amyloid – a toxic protein associated with Alzheimer’s – from the brain of mice and also, excitingly, in people.

“What is most compelling is that more amyloid was cleared when people took higher doses of the drug.
“No existing treatments for Alzheimer’s directly interfere with the disease process – and so a drug that actually slows the progress of the disease by clearing amyloid would be a significant step.”

He noted that the researchers had found some side-effects, such as headaches, and that the initial trial had not been designed to measure whether the drug slowed the decline in memory and thinking.

“While there were hints that it might have an effect on the symptoms of the disease, we need to see the results from further, larger research trials to understand whether this is the case. These larger trials are now under way, including in the UK, and due to finish in 2020,” Pickett said.

However, the report says, Gordon Wilcock, emeritus professor of geratology at Oxford University, was somewhat downbeat about the findings. “This is preliminary data about another monoclonal antibody targeting amyloid in Alzheimer’s disease, but whether it will really produce meaningful clinical benefit only definitive phase three clinical trials will show, as the researchers themselves state,” he said.

“We have already had previous trials of various anti-amyloid strategies, especially the monoclonal antibodies, that have failed to deliver at phase three.”

Alzheimer’s disease (AD) is characterized by deposition of amyloid-β (Aβ) plaques and neurofibrillary tangles in the brain, accompanied by synaptic dysfunction and neurodegeneration. Antibody-based immunotherapy against Aβ to trigger its clearance or mitigate its neurotoxicity has so far been unsuccessful. Here we report the generation of aducanumab, a human monoclonal antibody that selectively targets aggregated Aβ. In a transgenic mouse model of AD, aducanumab is shown to enter the brain, bind parenchymal Aβ, and reduce soluble and insoluble Aβ in a dose-dependent manner. In patients with prodromal or mild AD, one year of monthly intravenous infusions of aducanumab reduces brain Aβ in a dose- and time-dependent manner. This is accompanied by a slowing of clinical decline measured by Clinical Dementia Rating—Sum of Boxes and Mini Mental State Examination scores. The main safety and tolerability findings are amyloid-related imaging abnormalities. These results justify further development of aducanumab for the treatment of AD. Should the slowing of clinical decline be confirmed in ongoing phase 3 clinical trials, it would provide compelling support for the amyloid hypothesis.

Jeff Sevigny, Ping Chiao, Thierry Bussière, Paul H Weinreb, Leslie Williams, Marcel Maier, Robert Dunstan, Stephen Salloway, Tianle Chen, Yan Ling, John O’Gorman, Fang Qian, Mahin Arastu, Mingwei Li, Sowmya Chollate, Melanie S Brennan, Omar Quintero-Monzon, Robert H Scannevin, H Moore Arnold, Thomas Engber, Kenneth Rhodes, James Ferrero, Yaming Hang, Alvydas Mikulskis, Jan Grimm

The Independent report
Nature abstract
Nature comment

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