Gantenerumab for early Alzheimer’s disease: a systematic review and meta-analysis

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posted on 2024-06-16, 15:00 authored by Artur Menegaz de Almeida, Marianna Leite, Lucca Moreira Lopes, Pedro Gomes Lima, Maria Luísa Siegloch Barros, Samuel Rocha Pinheiro, Ítalo Andrade, Patrícia Viana, Victória Morbach, Gabriel Marinheiro, Ricardo de Oliveira, Agostinho C. Pinheiro

Gantenerumab is a monoclonal antibody targeting amyloid β protein (Aβ) in early Alzheimer’s disease (AD). The authors sought to evaluate gantenerumab safety and efficacy in early AD patients.

MEDLINE, Embase, and Cochrane databases were systematically searched until 2 December 2023. Data were examined using the Mantel–Haenszel method and 95% confidence intervals (CIs). Meta-regression analysis was conducted to evaluate a possible link between baseline Clinical Dementia Rating Scale – Sum of Boxes (CDR-SB) and amyloid-related imaging abnormalities (ARIA) at follow-up. R, version 4.2.3, was used for statistical analysis.

A total of 4 RCTs and 2848 patients were included, of whom 1580 (55%) received subcutaneous gantenerumab. Concerning clinical scores, the placebo group achieved better rates of change in the Disease Assessment Scale (ADAS-Cog13) (SMD −0.11; 95% CI −0.19– −0.03; p = 0.008569; I² = 0%). Gantenerumab was strongly associated with the occurrence of ARIA-E and ARIA-H: (19.67% vs. 2.31%; RR 9.46; 95% CI 5.55–16.11; p = <0.000001; I² = 10%) and (21.95% vs. 12.38%; RR 1.79; 95% CI 1.50–2.13; p = <0.000001; I² = 0%), respectively.

In this meta-analysis, consistent results suggest that gantenerumab is not safe and efficient for early AD, showing no improvement in clinical scores for AD and being associated with the occurrence of ARIA-E and ARIA-H.