Amyloid-related imaging abnormalities (ARIA) are a significant side effect of amyloid-lowering antibodies, such as aducanumab. Stephen Salloway, MD, Brown University, Butler Hospital, Providence, RI, explores the significance of ARIA in Alzheimer’s disease (AD) treatment and discusses what changes in monitoring recommendations have been implemented to reflect this. A high percentage of individuals do not experience symptoms from ARIA, however, there is still a risk of significant clinical events that need to be accounted for. Because of this, the FDA has updated prescribing guidelines and new appropriate use recommendations have been published, emphasizing the need to detect and manage ARIA early to minimize this risk. This has occurred in response to Phase III trial data assessing aducanumab use. MRI at baseline is recommended to ensure that patients are suitable for treatment: individuals should not have evidence of cerebral amyloid angiopathy, multiple microhemorrhages, multiple areas of superficial siderosis, or extensive cerebrovascular disease. Additional scans are also recommended within the first year as treatment dose is titrated. A conservative monitoring plan should be established with a multidisciplinary approach, to include professionals familiar with ARIA. Genetic testing prior to treatment is also now recommended, as patients with an APOE4 genotype are at greater risk of ARIA occurrence. This interview took place at the Alzheimer’s Association International Conference (AAIC) 2022 in San Diego, CA.
