Gantenerumab reduces amyloid-β plaques in patients with prodromal to moderate Alzheimer’s disease: a PET substudy interim analysis
Open accessAbstract
Background: We previously investigated low doses (105 or 225 mg) of gantenerumab, a fully human monoclonal antibody that binds and removes aggregated amyloid-β by Fc receptor-mediated phagocytosis, in the SCarlet RoAD (SR) and Marguerite RoAD (MR) phase 3 trials. Several lines of evidence suggested that higher doses may be necessary to achieve clinical efficacy. We therefore designed a positron emission tomography (PET) substudy to evaluate the effect of gantenerumab uptitrated to 1200 mg every 4 weeks on amyloid-β plaques as measured using florbetapir PET in patients with prodromal to moderate Alzheimer’s disease (AD). Methods: A subset of patients enrolled in the SR and MR studies who subsequently entered the open-label extensions (OLEs) were included in this substudy. Patients were aged 50 to 90 years with a clinical diagnosis of probable prodromal to moderate AD and were included based on a visual read of the original screening scan in the double-blind phase. Patients were assigned to 1 of 5 titration schedules (ranging from 2 to 10 months) with a target gantenerumab dose of 1200 mg every 4 weeks. The main endpoint of this substudy was change in amyloid-β plaque burden from OLE baseline to week 52 and week 104, assessed using florbetapir PET. Florbetapir global cortical signal was calculated using a prespecified standard uptake value ratio method converted to the Centiloid scale. Results: Sixty-seven of the 89 patients initially enrolled had ≥ 1 follow-up scan by August 15, 2018. Mean amyloid levels were reduced by 39 Centiloids by the first year and 59 Centiloids by year 2, a 3.5-times greater reduction than was seen after 2 years at 225 mg in SR. At years 1 and 2, 37% and 51% of patients, respectively, had amyloid-β plaque levels below the amyloid-β positivity threshold. Conclusion: Results from this exploratory interim analysis of the PET substudy suggest that gantenerumab doses up to 1200 mg resulted in robust amyloid-β plaque removal at 2 years. PET amyloid levels were consistent with sparse-to-no neuritic amyloid-β plaques in 51% of patients after 2 years of therapy. Amyloid reductions were similar to those observed in other placebo-controlled studies that have suggested potential clinical benefit. Trial registration: ClinicalTrials.gov, NCT01224106 (SCarlet RoAD) and NCT02051608 (Marguerite RoAD).
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Amyloid plaque burden must be lowered to approximately 20 centiloids for a significant clinical benefit to become apparent.
“amyloid plaque would need to be reduced to a low level (~20 centiloids) to reveal significant clinical benefit”
From The amyloid hypothesis in Alzheimer disease: new insights from new therapeutics (2022) · cites this paper as [89]
In cognitively unimpaired subjects, there is no meaningful increase in tau PET signal below 22 centiloids, although a 20% increase in amyloid PET SUVr up to about 35 centiloids was associated with a statistically significant increase in annualized tau PET signal.
“Jack et al. 89 have shown there is no meaningful increase in tau PET signal in cognitively unimpaired subjects below 22 CL, although an increase amyloid PET SUVr signal of 20% (up to ~35 CL) was associated with a statistically significant increase in annualized tau PET signal.”
From The amyloid hypothesis in Alzheimer disease: new insights from new therapeutics (2022) · cites this paper as [89]
Gantenerumab was found to be safe and well tolerated during Phase 1 clinical trials, except transient amyloid-related imaging abnormalities (ARIA) appeared in some patients given a high dosage.
“The antibody was found to be safe and well tolerated during the Phase 1 clinical trials, except that transient amyloid-related imaging abnormalities (ARIA) appeared in some patients given a high dosage.336”
From Amyloid β-based therapy for Alzheimer’s disease: Challenges, successes and future (2023) · cites this paper as [336]
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“The antibody was found to be safe and well tolerated during the Phase 1 clinical trials, except that transient amyloid-related imaging abnormalities (ARIA) appeared in some patients given a high dosage.(336) The initial results of phase 2 studies suggested gantenerumab may have no efficacy in the enrolled cohort.”
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- Authors
- Klein, G., Delmar, P., Voyle, N., Rehal, S., Hofmann, C., Abi-Saab, D., Andjelkovic, M., Ristic, S., Wang, G., Bateman, R., Kerchner, G. A., Baudler, M., Fontoura, P., & Doody, R.
- Affiliations
- F. Hoffmann-La Roche AG (CH)
- Roche (United Kingdom) (GB)
- Washington University in St. Louis (US)
- Corresponding author
- Klein, Gregory
- ORCID
- Venue
- Alzheimer's Research & Therapy
- Published
- 2019-12
- Volume
- 11
- Issue
- 1
- Pages
- 101-101
- ISSN
- 1758-9193 (ISSN-L)
- PMC
- PMC6909550
- OpenAlex
- W2995502746
- Cited by
- 212
- References
- 48
- Citations by year
- 2026: 7 · 2025: 22 · 2024: 39 · 2023: 40 · 2022: 50 · 2021: 33 · 2020: 21
- FWCI
- 17.84
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Alzheimer s Research & Therapy (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Digital Commons@Becker (Washington University School of Medicine) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- F. Hoffmann-La Roche (n/a)
- 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
- amyloid plaques, Alzheimer's disease, prodromal Alzheimer's disease, florbetapir PET, amyloid PET, monoclonal antibodies, Fc receptor-mediated phagocytosis, dose titration, amyloid-beta clearance, open-label extension
- MeSH terms
- Aged, Aged, 80 and over, Alzheimer Disease, Brain, Double-Blind Method, Female, Humans, Male, Middle Aged, Treatment Outcome, Positron-Emission Tomography, Plaque, Amyloid, Antibodies, Monoclonal, Humanized
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