ENGAGE and EMERGE: Truth and consequences?

ENGAGE and EMERGE: Truth and consequences?
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DOI:
10.1002/alz.12286
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发表时间:
2021-04
期刊:
Alzheimer's & dementia : the journal of the Alzheimer's Association
影响因子:
--
通讯作者:
Lopez OL
Lopez OL
中科院分区:
其他
文献类型:
--
作者:
Kuller LH;Lopez OL

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基于最近的EMERGE和ENGAGE临床试验的结果,抗淀粉样蛋白药物aducanumab的潜在益处产生了巨大的争议,并对未来的抗淀粉样蛋白药物治疗具有非常重要的意义。这两项为期18个月的试验是在轻度认知障碍(MCI)和早期痴呆患者中进行的。ENGAGE试验没有显示出任何益处,而高剂量EMERGE试验最初也没有显示出任何益处,但随着随访时间的延长,有了显著的积极益处。美国食品和药物管理局(FDA)咨询委员会最近的一项审查是否定的,而FDA神经药物办公室是肯定的,而统计学家则是否定的。这引发了关于该药物是否应该被批准,不被批准,需要一个新的临床试验,还是只批准一个子样本的争论。抗淀粉样蛋白药物治疗MCI和阿尔茨海默病(AD)患者的意义是非常重大的,以及脑淀粉样蛋白- AD -痴呆假说。
The potential benefit of the anti‐amyloid drug aducanumab based on results of recent EMERGE and ENGAGE clinical trials has generated great controversy and has very important implications for the future of anti‐amyloid drug therapies. The two trials of 18‐month duration were done in patients with mild cognitive impairment (MCI) and early dementia. The ENGAGE trial showed no benefit while the high‐dose EMERGE trial initially also showed no benefit but with longer follow‐up there was a significant positive benefit. A recent review form the U.S. Food and Drug Administration (FDA) Advisory Committee was negative while the FDA Office of Neurological Drugs was positive and the statisticians negative. This has generated debate about whether the drug should be approved, disapproved, require a new clinical trial, or approved for a subsample only. The implications for treating both MCI and Alzheimer's disease (AD) patients with anti‐amyloid drugs is very substantial as well as the brain amyloid‐AD‐dementia hypothesis.
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