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Meta-Analysis
. 2022;87(1):101-129.
doi: 10.3233/JAD-220046.

Safety and Efficacy of Monoclonal Antibodies for Alzheimer's Disease: A Systematic Review and Meta-Analysis of Published and Unpublished Clinical Trials

Eleonora Lacorte  1 , Antonio Ancidoni  1   2 , Valerio Zaccaria  3 , Giulia Remoli  1 , Leonardo Tariciotti  4 , Guido Bellomo  1 , Francesco Sciancalepore  1 , Massimo Corbo  5 , Flavia L Lombardo  1 , Ilaria Bacigalupo  1 , Marco Canevelli  1   3 , Paola Piscopo  6 , Nicola Vanacore  1
Affiliations
Meta-Analysis

Safety and Efficacy of Monoclonal Antibodies for Alzheimer's Disease: A Systematic Review and Meta-Analysis of Published and Unpublished Clinical Trials

Eleonora Lacorte et al. J Alzheimers Dis. 2022.

Abstract

Background: Monoclonal antibodies (mAbs) are currently among the most investigated targets for potential disease-modifying therapies in Alzheimer's disease (AD).

Objective: Our objectives were to identify all registered trials investigating mAbs in MCI due to AD or AD at any stage, retrieve available published and unpublished data from all registered trials, and analyze data on safety and efficacy outcomes.

Methods: A systematic search of all registered trials on ClinicalTrials.gov and EUCT was performed. Available results were searched on both platforms and on PubMed, ISI Web of Knowledge, and The Cochrane Library.

Results: Overall, 101 studies were identified on 27 mAbs. Results were available for 50 trials investigating 12 mAbs. For 18 trials, data were available from both published and unpublished sources, for 21 trials only from published sources, and for 11 trials only from unpublished sources. Meta-analyses of amyloid-related imaging abnormalities (ARIA) events showed overall risk ratios of 10.65 for ARIA-E and of 1.75 for ARIA-H. The meta-analysis of PET-SUVR showed an overall significant effect of mAbs in reducing amyloid (SMD -0.88), but when considering clinical efficacy, data on CDR-SB showed that treated patients had a statistically significant but clinically non-relevant lower worsening (MD -0.15).

Conclusion: Our results suggest that the risk-benefit profile of mAbs remains unclear. Research should focus on clarifying the effect of amyloid on cognitive decline, providing data on treatment response rate, and accounting for minimal clinically important difference. Research on mAbs should also investigate the possible long-term impact of ARIA events, including potential factors predicting their onset.

Keywords: Alzheimer’s disease; amyloid; meta-analysis; mild cognitive impairment; monoclonal antibodies; safety; systematic review; treatment outcome.

PubMed Disclaimer

Conflict of interest statement

Authors’ disclosures available online (https://www.j-alz.com/manuscript-disclosures/22-0046r1).

Figures

Fig. 1
Fig. 1
Flow diagram of identified published and unpublished studies.
Fig. 2
Fig. 2
Forest plot of the meta-analysis of available data on the frequency of ARIA-E.
Fig. 3
Fig. 3
Forest plot of the meta-analysis of available data on the frequency of ARIA-H.
Fig. 4
Fig. 4
Forest plot of the meta-analysis of available data on change from baseline in PET-SUVR.
Fig. 5
Fig. 5
Forest plot of the meta-analysis of available data on change from baseline in the CDR-SB score.
See this image and copyright information in PMC

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