Journal
ALZHEIMERS & DEMENTIA
Volume 17, Issue 6, Pages 1051-1055Publisher
WILEY
DOI: 10.1002/alz.12379
Keywords
Alzheimer's disease; anti-amyloid beta immunotherapy; Bayesian analysis; dementia; evidence of absence; meta-analysis; randomized controlled trial
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Funding
- Netherlands Organization for Health Research and Development (ZonMw) [91718303]
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Traditional frequentist meta-analysis did not find therapeutic effects of anti-Aβ immunotherapy in Alzheimer's disease, while Bayesian meta-analysis provided strong evidence supporting the absence of such effects. Exploring mechanisms other than Aβ removal may be necessary to slow the progression of Alzheimer's disease.
Numerous clinical trials of anti-amyloid beta (A beta) immunotherapy in Alzheimer's disease have been performed. None of these have provided convincing evidence for beneficial effects. Using traditional frequentist meta-analysis, the conclusion is that there is absence of evidence for a therapeutic effect, with a point estimate effect size of 0.05 (95% confidence interval -0.00 to 0.10, P = .055). In addition, this non-significant effect equates to 0.4 points per year on the cognitive subscale of the Alzheimer's Disease Assessment Scale. This is well below the minimally clinically important difference. Bayesian meta-analysis of these trial data provides strong evidence of absence of a therapeutic effect, with a Bayes factor of 11.27 in favor of the null hypothesis, opposed to a Bayes factor of 0.09 in favor of a treatment effect. Bayesian analysis is particularly valuable in this context of repeatedly reported small, non-significant effect sizes in individual trials. Mechanisms other than removal of A beta from the brain may be probed to slow progression of Alzheimer's disease.
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