Journal
ALZHEIMERS & DEMENTIA
Volume -, Issue -, Pages -Publisher
WILEY
DOI: 10.1002/alz.13431
Keywords
Alzheimer's disease; amyloid; clinical trials; personalized medicine; response to treatment
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This study provides a proof of concept for precision medicine in future research and drug development for Alzheimer's disease through individual treatment response analysis.
Introduction: Alzheimer's disease (AD) is a neurological disorder with variability in pathology and clinical progression. AD patients may differ in individual-level benefit from amyloid beta removal therapy.Methods: Random forest models were applied to the EMERGE trial to create an individual-level treatment response (ITR) score which represents individual-level benefit of high-dose aducanumab relative to the placebo. This ITR score was used to test the existence of heterogeneity in treatment effect (HTE).Results: We found statistical evidence of HTE in the Clinical Dementia Rating-Sum of Boxes (CDR-SB;P = 0.034). The observed CDR-SB benefit was 0.79 points greater in the group with the top 25% of ITR score compared to the remaining 75% (P = 0.020). Of note, the highest treatment responders had lower hippocampal volume, higher plasma phosphorylated tau 181 and a shorter duration of clinical AD at baseline.Discussion: This ITR analysis provides a proof of concept for precision medicine in future AD research and drug development.
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