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Authors & Affiliations
Danko Jeremic, Juan D Navarro-López, Lydia Jiménez-Díaz
Abstract
Regulatory approvals of Aducanumab in the U.S. and Lecanemab (U.S and Japan) for the treatment of Alzheimer’s disease (AD) have launched the worldwide marketing campaign for these antibodies as one of the first drugs that not only alleviate the symptoms but also slow AD progression. Another potent anti-amyloid antibody, Donanemab, may gain approval in the near future, as it is reported to reduce amyloid burden and slow AD progression. However, the risk/benefit profile of these drugs remains uncertain, and there is no obvious scientific basis for choosing between different antibodies. Here, we performed multiple meta-analyses through our self-programmed online open access app AlzMeta.app web application available at https://alzmetaapp.shinyapps.io/alzmeta/, to assess the efficacy and safety of anti-amyloid antibodies in phase III randomized placebo-controlled trials in sporadic AD. We synthesize and compare the results from conventional meta-analysis using DerSimonian-Laird random-effects model, frequentist network and Bayesian network meta-analysis. Primary outcomes were AD Assessment Scale-Cognitive Subscale, Mini Mental State Examination and Clinical Dementia Rating Scale-sum of Boxes. Secondary and tertiary outcomes included safety and biomarker measures (amyloid burden on PET). The meta-analysis included 16,716 patients in 17 trials testing five antibodies: Bapineuzumab, Solanezumab, Aducanumab, Lecanemab, and Donanemab. The results of this study show that Donanemab outperformed other drugs on all cognitive measures, while Lecanemab was the most efficient at reducing brain amyloid burden. Caution is necessary with the respect to cerebral edema and microbleeding, as Donanemab increased the risk of these events similarly as the approved antibodies. Funding: MICIN, PID2020-115823-GB100/ JCCM, SBPLY/21/180501/000150, ERDF.