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50/100

✓ Peer-reviewed alzhub usefulness score 50 out of 100. Prevention and risk

Topic: Amyloid, tau and blood-test diagnosis

Second-generation anti-amyloid monoclonal antibodies are emerging as a viable therapeutic option for individuals with prodromal and mild dementia due to Alzheimer's disease (AD). Passive immunotherapy with aducanumab (Aduhelm), lecanemab, donanemab, and gantenerumab all lower CNS amyloid (Aβ) burden but come with a significant risk of amyloid-related imaging abnormality (ARIA)-the most common side effect of this class of drugs. While usually asymptomatic and detected only on brain MRI, ARIA may lead to new signs and symptoms including headache, worsening confusion, dizziness, visual disturbances, nausea, and seizures. In addition, one fatality related to ARIA-E (edema) with aducanumab and one fatality due to ARIA-H (hemorrhage) with donanemab are reported to date. ARIA-E may be associated with excessive neuroinflammation and saturation of perivascular clearance pathways, while ARIA-H may be related to vascular amyloid clearance with weakening and rupture of small blood vessels. The risk of ARIA-E is higher at treatment initiation, in ApoE4 carriers, with higher dosage, and with >4 of microhemorrhages on a baseline MRI. The risk of ARIA-H increases with age and cerebrovascular disease. Dose titration mitigates the risk of ARIA, and contraindications include individuals with >4 microhemorrhages and those prescribed anti-platelet or anti-coagulant drugs. A brain MRI is required before aducanumab is initiated, before each scheduled dose escalation, and with any new neurologic sign or symptom. Management of ARIA ranges from continued antibody treatment with monthly MRI monitoring for asymptomatic individuals to temporary or permanent suspension for symptomatic individuals or those with moderate to severe ARIA on MRI. Controlled studies regarding prevention and treatment of ARIA are lacking, but anecdotal evidence suggests that a pulse of intravenous corticosteroids may be of benefit, as well as a course of anticonvulsant for seizures.

Cite this study APA, Vancouver, BibTeX · download .bib or .ris

APA 7th

Withington, C. G., & Turner, R. S. (2022). Amyloid-Related Imaging Abnormalities With Anti-amyloid Antibodies for the Treatment of Dementia Due to Alzheimer's Disease. Frontiers in neurology. https://doi.org/10.3389/fneur.2022.862369

Vancouver

Withington CG, Turner RS. Amyloid-Related Imaging Abnormalities With Anti-amyloid Antibodies for the Treatment of Dementia Due to Alzheimer's Disease. Frontiers in neurology. 2022. doi:10.3389/fneur.2022.862369. PMID: 35401412.

BibTeX

@article{withington2022-35401412,
  author  = {Withington, C. G. and Turner, R. S.},
  title   = {{Amyloid-Related Imaging Abnormalities With Anti-amyloid Antibodies for the Treatment of Dementia Due to Alzheimer's Disease}},
  journal = {Frontiers in neurology},
  year    = {2022},
  doi     = {10.3389/fneur.2022.862369},
  pmid    = {35401412},
  url     = {https://doi.org/10.3389/fneur.2022.862369}
}

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Key findings

Passive immunotherapy with aducanumab (Aduhelm), lecanemab, donanemab, and gantenerumab all lower CNS amyloid (Aβ) burden but come with a significant risk of amyloid-related imaging abnormality (ARIA)-the most common side effect of this class of drugs.
ARIA-E may be associated with excessive neuroinflammation and saturation of perivascular clearance pathways, while ARIA-H may be related to vascular amyloid clearance with weakening and rupture of small blood vessels.
Controlled studies regarding prevention and treatment of ARIA are lacking, but anecdotal evidence suggests that a pulse of intravenous corticosteroids may be of benefit, as well as a course of anticonvulsant for seizures.

Why it matters

Second-generation anti-amyloid monoclonal antibodies lower CNS amyloid burden but carry a significant risk of amyloid-related imaging abnormalities (ARIA), the most common side effect of this drug class. ARIA is usually asymptomatic but can cause symptoms and has been linked to one fatality with aducanumab and one with donanemab.

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Study details

Evidence strengthLow

How this study scored 50/100

Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.

Component	Points	Why
Journal tier	7 / 10	Tier 3 — peer-reviewed journal (Frontiers in neurology)
Journal's citation record	2 / 4	Frontiers in Neurology: journal h-index 162 (OpenAlex, 2026-10-29)
Study design	0 / 12	No study design recorded — scores zero, not guessed (not stated in the record — scored 0)
Strength of evidence	1 / 5	Rated “low” in our summary
Peer-review validation	10 / 10	Peer-reviewed. Published as an article in a named peer-reviewed journal.
How recent	3 / 5	2022 — within 6 year(s) of the newest study here
Sample size	0 / 4	Participant count not stated — scores zero (not stated in the record — scored 0)
Effect reported	0 / 3	No effect size reported — scores zero (not stated in the record — scored 0)
Studied in people	0 / 3	Not stated whether this was studied in people — scores zero (not stated in the record — scored 0)
Randomised / blinded	0 / 2	No randomisation or blinding stated — scores zero (not stated in the record — scored 0)
Times cited	5 / 7	Cited 149 times (OpenAlex, 2026-10-10)
Citations per year	4 / 5	24.8 citations a year over 6 year(s) since 2022
Impact for its field and year	4 / 6	Cited 16.2× the average for papers of its field and year (OpenAlex FWCI)
Cited by studies here	3 / 6	Cited by 16 other studies in this library
Still being cited	3 / 4	Cited 107 times in 2024–2026 (2026 still in progress; OpenAlex)
Senior author's track record	3 / 4	Last-listed author Raymond Scott Turner: h-index 84 (OpenAlex, whole career)
Institution's track record	1 / 3	Georgetown University: institution h-index 824 (OpenAlex)
Multi-centre collaboration	0 / 3	OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete)
Indexed in PubMed	2 / 2	Indexed in PubMed (PMID 35401412)
Free to read	2 / 2	Free to read
Total	50 / 100	—

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