Anti-amyloid treatments in Alzheimer’s disease: elegance, evidence and ethics
| dc.rights.license | open | en_US |
| hal.structure.identifier | Bordeaux population health [BPH] | |
| dc.contributor.author | DALY, Timothy | |
| dc.contributor.author | OLLURI, Andi | |
| dc.contributor.author | KURKINEN, Markku | |
| dc.date.accessioned | 2025-01-08T10:14:08Z | |
| dc.date.available | 2025-01-08T10:14:08Z | |
| dc.date.issued | 2024-12-19 | |
| dc.identifier.issn | 1899-5276 | en_US |
| dc.identifier.uri | https://oskar-bordeaux.fr/handle/20.500.12278/204191 | |
| dc.description.abstractEn | The so-called "amyloid cascade hypothesis" provides an elegant explanation of Alzheimer's disease (AD), has motivated the amyloid-lowering therapeutic strategy, and led to the elaboration of a rich experimental and conceptual toolkit for the field to progress. But it might be incorrect. The scientific evidence base supporting the efficacy and safety of current anti-amyloid antibody treatments in AD is weak. Nevertheless, we argue that there is a bias towards the amyloid-lowering therapeutic strategy amongst key opinion leaders in the research and advocacy communities. To demonstrate this, we first focus on the AD lexicon: while any accrual of amyloid on a brain PET scan can now permit diagnosis/definition of AD, lowering positron emission tomography (PET) amyloid is considered disease modification, and treatment-induced side-effects are hidden behind neutral-sounding acronyms: ARIA (amyloid-β (Aβ)-related imaging abnormalities: brain bleeding and swelling) and ARPA (amyloid-β (Aβ) removal-related pseudo-atrophy: brain shrinkage). Second, we underline that drugmakers did not test anti-amyloid antibodies against the best proven interventions and did not adequately inform trial participants of risks, thus violating research ethics of the Declaration of Helsinki on 2 counts. In conclusion, we are critical of over-reliance on the idea that PET amyloid-lowering treatments for AD are a therapeutic revolution as claimed, and consider that optimism does not excuse a lack of scientific, regulatory, and ethical integrity. We argue for rigorous, properly controlled (e.g. donepezil) anti-amyloid trials demonstrating cognitive and functional benefit before accepting amyloid-lowering drugs as the new standard of care for AD patients. | |
| dc.language.iso | EN | en_US |
| dc.rights | Attribution 3.0 United States | * |
| dc.rights.uri | http://creativecommons.org/licenses/by/3.0/us/ | * |
| dc.subject.en | Alzheimer’s Disease | |
| dc.subject.en | Amyloid Hypothesis | |
| dc.subject.en | Bias | |
| dc.subject.en | Clinical Trials | |
| dc.subject.en | Ethics | |
| dc.title | Anti-amyloid treatments in Alzheimer’s disease: elegance, evidence and ethics | |
| dc.title.alternative | Adv Clin Exp Med | en_US |
| dc.type | Article de revue | en_US |
| dc.identifier.doi | 10.17219/acem/198674 | en_US |
| dc.subject.hal | Sciences du Vivant [q-bio]/Santé publique et épidémiologie | en_US |
| dc.identifier.pubmed | 39698778 | en_US |
| bordeaux.journal | Advances in Clinical and Experimental Medicine | en_US |
| bordeaux.page | 1303-1309 | en_US |
| bordeaux.volume | 33 | en_US |
| bordeaux.hal.laboratories | Bordeaux Population Health Research Center (BPH) - UMR 1219 | en_US |
| bordeaux.issue | 12 | en_US |
| bordeaux.institution | Université de Bordeaux | en_US |
| bordeaux.institution | INSERM | en_US |
| bordeaux.team | ACTIVE_BPH | en_US |
| bordeaux.peerReviewed | oui | en_US |
| bordeaux.inpress | non | en_US |
| bordeaux.import.source | crossref | |
| hal.identifier | hal-04873123 | |
| hal.version | 1 | |
| hal.date.transferred | 2025-01-08T10:14:11Z | |
| hal.popular | non | en_US |
| hal.audience | Internationale | en_US |
| hal.export | true | |
| workflow.import.source | crossref | |
| dc.rights.cc | Pas de Licence CC | en_US |
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