Aducanumab: an uprising hope with vague horizons

Abstract

Alzheimer’s disease (AD) is the leading cause of dementia worldwide. Amyloid-beta (Aβ) deposition, is one of the processes involved in the pathophysiology of AD, has inspired interest in targeted therapies, including monoclonal antibodies. Aducanumab acts as a fully human IgG1 monoclonal antibody against Aβ by binding to amyloid plaques and was approved by the Food and Drug Administration (FDA) as the first disease-modifying drug for mild cognitive impairment and mild stages of AD. This accelerated approval, albeit the termination of the two phase III clinical trials of aducanumab due to results of futility analysis, has provoked controversy among the key opinion leaders in the field of cognitive neurology. Aducanumab poses significant financial constraints on patients and healthcare systems. Furthermore, the precise diagnosis of AD stages for appropriate aducanumab initiation remains a formidable challenge. The drug’s administration necessitates specialized infrastructure and medical equipment, and it may induce amyloid-related imaging abnormalities (ARIA), potentially resulting in cerebral edema or hemorrhage. These disadvantages might outweigh the potential benefits of the medication, especially considering the uncertainties regarding its efficacy. This commentary is intended to briefly evaluate the application of aducanumab in developing countries, considering the associated diagnostic challenges, clinical efficacy, cost, and potential adverse effects.