Maximus Peto’s Commentary
This group reports disappointing results of intravenous monoclonal beta-amyloid (1-40) antibody, ponezumab, in patients with cerebral amyloid angiopathy.
Immunotherapy with ponezumab for probable cerebral amyloid angiopathy.
Ann Clin Transl Neurol. 2019 Mar 18;6(4):795-806.
Leurent C, Goodman JA, Zhang Y, He P, Polimeni JR, Gurol ME, Lindsay M, Frattura L, Sohur US, Viswanathan A, Bednar MM, Smith EE; Ponezumab Trial Study Group, Greenberg SM
PubMed publication date (edat): 4/26/2019
Cerebral amyloid angiopathy (CAA) is caused by cerebrovascular deposition of β-amyloid fragments leading to cerebrovascular dysfunction and other brain injuries. This phase 2, randomized, double-blind trial in patients with probable CAA assessed the efficacy and safety of ponezumab, a novel monoclonal antibody against Aβ 1-40.
Thirty-six participants aged 55-80 years with probable CAA received intravenous placebo (n = 12) or ponezumab (n = 24). The change from baseline to Days 2 and 90 in cerebrovascular reactivity (CVR) was measured in the visual cortex as the natural log of the rising slope of the BOLD fMRI response to a visual stimulus. Safety and tolerability were also assessed.
The mean change from baseline to Day 90 was 0.817 (ponezumab) and 0.958 (placebo): a mean ratio of 0.852 (90% CI 0.735-0.989) representing a trend towards reduced CVR in the ponezumab group. This trend was not present at Day 2. There was one asymptomatic occurrence of amyloid-related imaging abnormality-edema in the ponezumab group. The total number of new cerebral microbleeds from baseline to day 90 did not differ between groups. The ponezumab group had a participant with nonfatal new cerebral hemorrhage with aphasia and a participant with subdural hemorrhage that site investigators deemed to be nondrug related. In the placebo group one participant had a fatal intracerebral hemorrhage and one participant had migraine with aura.
Ponezumab was safe and well-tolerated. The ponezumab group showed a trend towards treatment effect at Day 90 that was opposite to the hypothesized direction. The prespecified efficacy criteria were thus not met.
Free Full-Text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469253/