Initial Experiences with Amyloid-Related Imaging Abnormalities in Patients Receiving Aducanumab Following Accelerated Approval

Aducanumab is the first FDA-approved amyloid-lowering immunotherapy for Alzheimer's disease. There is little real-world data to guide management of amyloid-related imaging abnormalities (ARIA), a potentially serious side-effect which requires surveillance with magnetic resonance imaging. We report our experiences in managing ARIA in patients receiving aducanumab at the Butler Hospital Memory and Aging Program during the year following FDA approval. We followed the Appropriate Use Recommendations for aducanumab to guide patient selection, detection, and management of ARIA (1). ARIA-E occurred in 6 out of 24 participants treated; all APOE-e4 carriers. Treatment was discontinued in 4 cases of moderate-severe ARIA-E, temporarily held in 1 moderate case, and dosed through in 1 mild case (mean duration = 3 months, range, 1-6 months). No participants required hospitalization or high dose corticosteroids. Participants on anticoagulation were excluded and no macrohemorrhages occurred. These data support the measured approaches to treatment outlined in the Appropriate Use Recommendations.

Automated summary

Aducanumab is the first FDA-approved immunotherapy for Alzheimer's disease that lowers amyloid levels. The management of amyloid-related imaging abnormalities (ARIA), a potential serious side effect of the treatment, lacks real-world data. In this study, we share our experiences in managing ARIA in patients treated with aducanumab. Six out of 24 participants developed ARIA-E, all of whom were carriers of the APOE-e4 gene. Treatment was discontinued in four cases of moderate-severe ARIA-E, temporarily paused in one moderate case, and continued in one mild case. No hospitalizations or high dose corticosteroids were required. These findings support the use of measured approaches outlined in the Appropriate Use Recommendations.