Diving Into the Potential of Monoclonal Antibodies for Alzheimer Disease Treatment: Gayatri Devi, MD

WATCH TIME: 8 minutes

“It seems that when you do this slower titration, there’s a much-reduced risk of ARIA (amyloid-related imaging abnormalities). In our patient sample, we had a 0% risk of brain bleeding and brain swelling in patients who are aducanumab. Now the question is, when do you put patients on it? Is it worth putting patients on it?”

The clinical approach to Alzheimer disease (AD) is challenging and accurate diagnosis is crucial, especially given the significant side effects, including brain hemorrhage, of newer monoclonal antibodies approved for treating the earlier stages of AD.¹ Recently published in the Journal of the American Geriatrics Society, a research letter written by Gayatri Devi, MD, MS, FACP, FAAN, director at Park Avenue Neurology, discussed the use of aducanumab (Aduhelm; Biogen) in a community-based clinical setting for AD and mild cognitive impairment.²

In the research, Devi retrospectively reviewed data from 20 patients who received the agent and observed that none developed clinically apparent brain abnormalities, except for transient headaches in 2 homozygous carriers. By adopting a slower titration approach for ApoEε4 carriers, she thought this might help reduce adverse effects of these antiamyloid therapies. Recently, Devi, clinical professor of neurology at SUNY Downstate Medical Center, Lenox Hill Hospital/Northwell Health, presented her real-world experience with antiamyloids in the session based on neurocognitive disorders, at the 2023 International Congress on the Future of Neurology (IFN) Annual Meeting, held September 22-23, in Jersey City, New Jersey.

Following the meeting, Devi sat down in an interview with NeurologyLive® to discuss how the different monoclonal antibody drugs for AD, like aducanumab and lecanemab (Leqembi, Eisai), target distinct epitopes, and how this might affect their efficacy. She talked about the major challenges and risks, particularly related to ARIA, when using monoclonal antibodies for AD treatment, and how these risks can be mitigated. Additionally, Devi spoke about what criteria should be considered when selecting patients with AD for monoclonal antibody therapy, and how maintaining cognitive function factors into the decision-making process.

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REFERENCES
1. Devi G. A how-to guide for a precision medicine approach to the diagnosis and treatment of Alzheimer’s disease. Front Aging Neurosci. 2023;15:1213968. Published 2023 Aug 17. doi:10.3389/fnagi.2023.1213968
2. Devi G. Tolerability and safety with aducanumab in Alzheimer’s disease in a community-based setting on a slower titration schedule. J Am Geriatr Soc. 2023;71(2):671-672. doi:10.1111/jgs.18059