Abstract
Background and Objectives Treatment options for Alzheimer's Disease (AD) are limited and have focused mainly on symptomatic therapy and improving quality of life. Recently, lecanemab, an anti-beta amyloid monoclonal antibody (mAbs), received accelerated approval by the U.S. Food and Drug Administration for treatment in the early stages of biomarker-confirmed symptomatic AD. An additional anti-beta amyloid mAbs, aducanumab, was approved in 2021, and more will potentially become available in the near future. Research on the applicability and generalizability of the anti-beta amyloid mAbs eligibility criteria on adults with biomarkers available in the general population has been lacking. The study's primary aim was to apply the clinical trial eligibility criteria for lecanemab treatment to participants with early AD of the population-based Mayo Clinic Study of Aging (MCSA) and assess the generalizability of anti-amyloid treatment. The secondary aim of the study was to apply the clinical trial eligibility criteria for aducanumab treatment in MCSA participants.
Methods The present cross-sectional study aimed to apply the clinical trial eligibility criteria for lecanemab and aducanumab treatment to participants with early AD of the population-based MCSA and assess the generalizability of anti-amyloid treatment.
Results Two hundred thirty-seven MCSA participants ( mean age (standard deviation) 80.9 (6.3) years, 54.9% male and 97.5 % White) with mild cognitive impairment (MCI) or mild dementia and increased brain amyloid burden by PiB PET comprised the study sample. Lecanemab trial's inclusion criteria reduced the study sample to 112 (47.3% of 237) participants. The trial's exclusion criteria further narrowed the number of potentially eligible to 19 (overall 8% of 237). Modifying the exclusion criteria to include all participants with MCI (instead of applying additional cognitive criteria) resulted in 17.4% of participants with MCI being eligible for lecanemab treatment. One hundred and four participants (43.9% of 237) fulfilled the aducanumab clinical trial's inclusion criteria. The aducanumab trial's exclusion criteria further reduced the number of available participants, narrowing those eligible to 12 (5.1% of 237). Common exclusions related to other chronic conditions and neuroimaging findings.
Discussion Findings estimate the limited eligibility in typical older adults with cognitive impairment for anti-beta amyloid mAbs.
- Received March 7, 2023.
- Accepted in final form August 4, 2023.
- Copyright © 2023 American Academy of Neurology. Unauthorized reproduction of this article is prohibited
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