Enhanced Dosing of Donanemab Lowers ARIA Risk, Anti-Tau Agent E2814 Shows Promising Results, Combination Approach of Intranasal Insulin and Empagliflozin

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Welcome to this special edition of Neurology News Network. I'm Marco Meglio. This week’s news coverage centers around research rpesented at the 2024 Clinical Trials on Alzheimer’s Disease conference, held in Madrid, Spain.

New findings from the phase 3b TRAILBLAZER-ALZ-6 trial (NCT05738486), a study of the recently approved antiamyloid treatment donanemab (Kisulna; Eli Lilly), showed that an enhanced titration dosing regimen of the treatment led to significant reductions in the frequency and severity of amyloid-related imaging abnormalities-edema (ARIA-E). In addition to numerically lower ARIA-E at 24 weeks, those on the titrated dosing regimen also maintained sufficient amyloid reduction.In the study, 843 adults with early symptomatic Alzheimer disease (AD) were stratified by apolipoprotein (APOE) genotype and baseline amyloid levels and randomly assigned to the standard dosing arm or 1 of 3 alternative dosing arms in a 1:1:1:1 ratio. By week 24, the frequency of ARIA-E was 23.7% for the standard dosing arm, and 18.6%, 13.7%, and 18.3% for the 3 alternative dosing arms.

Data from E2814-G000-103, an open-label, phase 1b/2 study (NCT04971733) of patients with dominantly inherited Alzheimer disease (DIAD), showed that treatment with E2814 (Eisai), an investigational anti-tau therapeutic antibody, resulted in significant effect on both early and late tau biomarkers in treated patients. Notably, E2814 did not affect phosphorylated tau (p-tau)217 or MTBR-tau243 levels in healthy volunteers, suggesting its effects are specific to those with tau pathology and thus further supporting its clinical development. Presented at the 2024 Clinical Trials on Alzheimer’s Disease (CTAD) conference, held October 29-November 1 in Madrid, Spain, the study featured 8 participants who each received E2814 intravenously (IV) every 4 weeks escalating from 750 mg, 1500 mg, 3000 mg, to 4500 mg (min of 3 doses/dose level). Following the 4500 mg dosage, patients stayed on 4500 mg for up to 108 weeks. To be included, patients had a confirmed mutation for presenilin 1 (PSEN1), amyloid precursor positive, or presenilin 2 (PSEN2) gene that is also associated with DIAD. Patients also had to have a Clinical Dementia Rating-Sum of Boxes score between 5 to 12 at screening, as well as undergo MRI, lumbar puncture, and PET.

New data from a placebo-controlled phase 2 trial (NCT05081219) showed that a combination treatment approach with intranasal insulin (INI) and empagliflozin (empa), two compounds that improve metabolic and vascular function, had positive effects on cognition and several other immune/inflammatory biomarkers in patients with mild cognitive impairment (MCI) or early Alzheimer disease (AD). Overall, the data supported the continued investigation of this combination method for AD and suggest these agents may also be useful in combination with approved anti-amyloid therapies. Otherwise known as the SNIFF study, patients with MCI or early AD, or amyloid positive controls with memory complaints were assigned to 1 of 4 arms: placebo, INI (40 IU QID regular insulin), empa (10 mg QD), or insulin plus empa (INI+empa). Over a 4-week treatment period, investigators compared insulin-treated (INI and INI+empa) vs non-insulin-treated (placebo and empa only) patients on cerebrospinal fluid (CSF) and plasma biomarkers, diffusion tensor imaging (DTI) global white matter fractional anisotropy, and cognitive function.

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