Cited by 701Alzheimer's disease research and treatmentsDementia and Cognitive Impairment ResearchNeuroinflammation and Neurodegeneration Mechanisms

11C-PiB PET assessment of change in fibrillar amyloid-β load in patients with Alzheimer's disease treated with bapineuzumab: a phase 2, double-blind, placebo-controlled, ascending-dose study

Rinne, Juha O, Brooks, David J, Rossor, Martin N, Fox, Nick C, Bullock, Roger, Klunk, William E, Mathis, Chester A, Blennow, Kaj +9 more·2010·The Lancet Neurology

Abstract

Background Carbon-11-labelled Pittsburgh compound B ((11)C-PiB) PET is a marker of cortical fibrillar amyloid-beta load in vivo. We used (11)C-PiB PET to investigate whether bapineuzumab, a humanised anti-amyloid-beta monoclonal antibody, would reduce cortical fibrillar amyloid-beta load in patients with Alzheimer's disease.Methods Patients with mild-to-moderate Alzheimer's disease were randomly assigned to receive intravenous bapineuzumab or placebo in a ratio of seven to three in three ascending dose groups (0.5, 1.0, or 2.0 mg/kg). Each dose group was enrolled after safety review of the previous group. Randomisation was by interactive voice response system; masking was achieved with numbered kit allocation. Patients, investigators, study site personnel, sponsor staff, and carers were masked to treatment. Patients received up to six infusions, 13 weeks apart, and had (11)C-PiB PET scans at baseline and at weeks 20, 45, and 78. The primary outcome was the difference between the pooled bapineuzumab group and the pooled placebo group in mean change from screening to week 78 in (11)C-PiB cortical to cerebellar retention ratio averaged across six cortical regions of interest. Analysis was by modified intention to treat. This study is registered with EudraCT, number 2004-004120-12; ISRCTN17517446.Findings 28 patients were assigned to bapineuzumab (n=20) or placebo (n=8). 19 patients in the bapineuzumab group and seven in the placebo group were included in the modified intention-to-treat analysis. Estimated mean (11)C-PiB retention ratio change from baseline to week 78 was -0.09 (95% CI -0.16 to -0.02; p=0.014) in the bapineuzumab group and 0.15 (95% CI 0.02 to 0.28; p=0.022) in the placebo group. Estimated mean difference in (11)C-PiB retention ratio change from baseline to week 78 between the bapineuzumab group and the placebo group was -0.24 (95% CI -0.39 to -0.09; p=0.003). Differences between the bapineuzumab group and the placebo group in the individual regions of interest were similar to the overall mean difference. Adverse events were typically mild to moderate in severity and transient. Two patients in the 2.0 mg/kg bapineuzumab group had transient cerebral vasogenic oedema.Interpretation Treatment with bapineuzumab for 78 weeks reduced cortical (11)C-PiB retention compared with both baseline and placebo. (11)C-PiB PET seems to be useful in assessing the effects of potential Alzheimer's disease treatments on cortical fibrillar amyloid-beta load in vivo.Funding Elan Pharmaceuticals and Wyeth Research.

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Crossref · 10.1016/s1474-4422(10)70043-0

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  • Several anti-Aβ monoclonal antibodies tested in clinical trials in AD patients significantly reduce load of fibrillar Aβ as demonstrated using PET Aβ imaging.

    “Several anti-Aβ monoclonal antibodies (mAbs) have been tested in clinical trials in AD patients and were found to significantly reduce load of fibrillar Aβ as demonstrated using PET Aβ imaging [5–8].”
  • In phase 2 clinical studies, bapineuzumab reduced cerebrospinal fluid phospho-tau in patients with mild-to-moderate Alzheimer's disease.

    “In phase 2 clinical studies involving patients with mild-to-moderate Alzheimer’s disease, patients who received bapineuzumab, as compared with those who received placebo, had a greater reduction in amyloid on positron-emission tomographic amyloid imaging with the use of Pittsburgh compound B (PIB-PET) and reduced cerebrospinal fluid phosphorylated tau (phospho-tau), suggesting target engagement”
  • In phase 2 clinical studies, bapineuzumab reduced amyloid on PIB-PET more than placebo in patients with mild-to-moderate Alzheimer's disease.

    “In phase 2 clinical studies involving patients with mild-to-moderate Alzheimer’s disease, patients who received bapineuzumab, as compared with those who received placebo, had a greater reduction in amyloid on positron-emission tomographic amyloid imaging with the use of Pittsburgh compound B (PIB-PET) and reduced cerebrospinal fluid phosphorylated tau (phospho-tau), suggesting target engagement”
  • The reduction in amyloid accumulation on PIB-PET in APOE ε4 carriers was smaller than that seen in phase 2 studies that included the 2.0 mg/kg dose.

    “A decreased rate of accumulation of amyloid in the brain on PIB-PET was seen in APOE ε4 carriers who received bapineuzumab, but the difference was smaller than that seen in phase 2 studies, which included the 2.0-mg-per-kilogram dose.10”
  • One of the antibodies to Aβ appears to reduce plaque burden.

    “One of these antibodies, which to date has not yet reported any post-hoc evidence of clinical efficacy in its phase 3 trials, appears to reduce plaque burden [253].”

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Authors
Rinne, J. O., Brooks, D. J., Rossor, M. N., Fox, N. C., Bullock, R., Klunk, W. E., Mathis, C. A., Blennow, K., Barakos, J., Okello, A. A., de LIano, S. R. M., Liu, E., Koller, M., Gregg, K. M., Schenk, D., Black, R., & Grundman, M.
Affiliations
  • University of Turku (FI)
  • Imperial College London (GB)
  • UCL Queen Square Institute of Neurology (GB)
  • University of Pittsburgh Medical Center (US)
  • Sahlgrenska University Hospital (SE)
  • California Pacific Medical Center (US)
  • Janssen Alzheimer Immunotherapy Research & Development (United States) (US)
  • Elan Pharmaceuticals, Inc. (Ireland) (IE)
  • Pfizer (United States) (US)
Corresponding author
Rinne, Juha O
Venue
The Lancet Neurology
Publisher
Elsevier BV
Published
2010-04
Volume
9
Issue
4
Pages
363-372
ISSN
1474-4422 (ISSN-L)
OpenAlex
W2150231759
Cited by
701
References
37
Citations by year
2026: 7 · 2025: 10 · 2024: 13 · 2023: 20 · 2022: 31 · 2021: 31 · 2020: 34 · 2019: 16 · 2018: 33 · 2017: 38 · 2016: 48 · 2015: 47 · 2014: 73 · 2013: 97 · 2012: 77
FWCI
64.97
Type
journal article
Language
en
Open access
closed
Locations
  • The Lancet Neurology (publishedVersion)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • Digital Academic REpository of VU University Amsterdam (Vrije Universiteit Amsterdam) (submittedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Funders
National Institute for Health and Care Research (NF-SI-0508-10123)
Topics
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Life Sciences › Neuroscience › Neurology › Neuroinflammation and Neurodegeneration Mechanisms
Keywords
bapineuzumab, Alzheimer's disease, amyloid-beta, 11C-PiB PET, anti-amyloid monoclonal antibodies, amyloid PET, treatment response assessment, dose escalation, mild to moderate Alzheimer's disease, anti-amyloid therapy
MeSH terms
Aged, Alzheimer Disease, Aniline Compounds, Antibodies, Monoclonal, Brain, Brain Mapping, Dose-Response Relationship, Drug, Double-Blind Method, Female, Humans, Immunologic Factors, Male, Severity of Illness Index, Thiazoles, Time Factors, Amyloid beta-Peptides, Treatment Outcome, Positron-Emission Tomography, Antibodies, Monoclonal, Humanized

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