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amyloid-related imaging abnormality-edema, effusions, hemorrhage or siderosis (ARIA-E, ARIA-H)

Etiology: - anti-Alzheimer monoclonal antibodies targeting beta-amyloid - 41% of patients receiving aducanumab 10 mg/kg* (most within the 1st 8 doses) - 13% of patients receiving lecanemab 10 mg/kg* * 2-3% of placebo recipients in aducanumab clinical trial with ARIA-E * incidence dose-related [3] Pathology: - cerebral edema - cerebral hemorrhage Genetics: - incidence highest in apolipoprotein E4 carriers [2] Clinical manifestations: - headache (47%) - confusion (15%) - dizziness (11%) - nausea (8%) [2] Radiology: - abnormalities seen on MRI neuroimaging* - 98% resolve, 83% within 16 weeks (weeks) Management: - glucocorticoids for severe disease

General

abnormal imaging

References

  1. George J Alzheimer's Drug Slows Decline, Trial Data Show. Lecanemab met primary and secondary endpoints, but was associated with adverse events. MedPage Today November 30, 2022 https://www.medpagetoday.com/neurology/alzheimersdisease/101972 - van Dyck CH, Swanson CJ, Aisen P Lecanemab in Early Alzheimer's Disease. N Engl J Med 2022. Nov 29. PMID: 36449413 https://www.nejm.org/doi/full/10.1056/NEJMoa2212948
  2. Salloway S, Chalkias S, Barkhof F et al Amyloid-Related Imaging Abnormalities in 2 Phase 3 Studies Evaluating Aducanumab in Patients With Early Alzheimer Disease. JAMA Neurol. 2022 Jan 1;79(1):13-21. PMID: 34807243 PMCID: PMC8609465 Free PMC article. Clinical Trial.
  3. Filippi M, Cecchetti G, Spinelli EG, Vezzulli P, Falini A, Agosta F. Amyloid-Related Imaging Abnormalities and beta-Amyloid-Targeting Antibodies: A Systematic Review. JAMA Neurol. 2022 Mar 1;79(3):291-304 PMID: 35099507 Review. https://jamanetwork.com/journals/jamaneurology/fullarticle/2788269