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P. Scheltens, E. Vijverberg (2021)
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Trial of Solanezumab for Mild Dementia Due to Alzheimer's DiseaseThe New England Journal of Medicine, 378
INTRODUCTIONARIA in Alzheimer's disease backgroundOver the past decade, an active area of research has been the development of immunotherapy, with the goal of lowering cerebral amyloid beta burden in patients with Alzheimer's disease (AD).1–7 Treatment‐related amyloid‐related imaging abnormalities (ARIA) have been observed on brain imaging after treatment with some anti‐amyloid immunotherapies. The exact pathophysiology underlying ARIA remains uncertain.8–12 ARIA‐E (edema) refers to the magnetic resonance (MR) signal alterations thought to represent vasogenic edema (VE) and related extravasated fluid phenomena, whereas ARIA‐H (hemorrhage) refers to the MR signal alterations attributable to microhemorrhages, macrohemorrhages, and hemosiderosis (superficial siderosis8). ARIA‐E and ARIA‐H are typically detected on magnetic resonance imaging (MRI) sequences. Both appear to relate to the presence of cerebral amyloid angiopathy (CAA), and both occur in the natural history of AD and in the setting of amyloid‐modifying therapeutic approaches.8 Microhemorrhages naturally occur frequently in AD. Macrohemorrhages, siderosis, and edema occur only rarely in AD without treatments and are thought to be associated with CAA, but are observed at higher rates with antibody treatments. Current practice implements careful clinical and radiographic monitoring for ARIA when treating with an anti‐amyloid therapy.13RESEARCH IN CONTEXTSystematic Review: The authors reviewed the literature utilizing PubMed and recent
Alzheimer s & Dementia Translational Research & Clinical Interventions – Wiley
Published: Jan 1, 2023
Keywords: Alzheimer's disease; anti‐amyloid; ARIA; exposure response modeling; lecanemab
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