Susanne Ostrowitzki1, Tobias Bittner1,2, Kaycee M Sink2, Howard Mackey2, Christina Rabe2, Lawrence S Honig3, Emanuele Cassetta4, Michael Woodward5,6, Mercè Boada7,8, Christopher H van Dyck9, Timo Grimmer10, Dennis J Selkoe11, Andres Schneider1, Kathleen Blondeau1, Nan Hu2, Angelica Quartino2,12, David Clayton2, Michael Dolton13, Yifan Dang11,14, Beth Ostaszewski11, Sandra M Sanabria-Bohórquez2, Michael Rabbia2, Balazs Toth2, Udo Eichenlaub15, Jillian Smith16, Lee A Honigberg2, Rachelle S Doody1,2. 1. F. Hoffmann-La Roche Ltd, Basel, Switzerland. 2. Genentech, Inc, South San Francisco, California. 3. Taub Institute and Department of Neurology, Columbia University Irving Medical Center, New York, New York. 4. Fatebenefratelli Foundation, Associazione Fatebenefratelli Per la Ricerca Division, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy. 5. Austin Health Continuing Care Clinical Service Unit, Heidelberg, Germany. 6. University of Melbourne, Melbourne, Victoria, Australia. 7. Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya, Barcelona, Spain. 8. Networking Research Center on Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain. 9. Alzheimer's Disease Research Unit, Yale School of Medicine, New Haven, Connecticut. 10. Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany. 11. Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. 12. Clinical Pharmacology and Quantitative Pharmacology, AstraZeneca, Gothenburg, Sweden. 13. Roche Products Australia Pty Ltd, Sydney, New South Wales, Australia. 14. Sanofi Genzyme, Waltham, Massachusetts. 15. Roche Diagnostics GmbH, Penzberg, Germany. 16. Roche Products Ltd, Welwyn Garden City, United Kingdom.
Abstract
Importance: Alzheimer disease (AD), a neurodegenerative disease characterized by β-amyloid plaques and τ tangles in the brain, represents an unmet medical need with no fully approved therapeutics to modify disease progression. Objective: To investigate the safety and efficacy of crenezumab, a humanized monoclonal immunoglobulin G4 antibody targeting β-amyloid oligomers, in participants with prodromal to mild (early) AD. Design, Setting, and Participants: Two phase 3 multicenter randomized double-blind placebo-controlled parallel-group efficacy and safety studies of crenezumab in participants with early AD, CREAD and CREAD2, were initiated in 2016 and 2017, respectively, and were designed to evaluate the efficacy and safety of crenezumab in participants with early AD. CREAD (194 sites in 30 countries) and CREAD2 (209 sites in 27 countries) were global multicenter studies. A total of 3736 and 3664 participants were screened in CREAD and CREAD2, respectively. A total of 3736 and 3664 participants were screened in CREAD and CREAD2, respectively. Both trials enrolled individuals aged 50 to 85 years with early AD. Participants with some comorbidities and evidence of cerebral infarction or more than 4 microbleeds or areas of leptomeningeal hemosiderosis on magnetic resonance imaging were excluded. After 2923 and 2858 were excluded, respectively, 813 participants in CREAD and 806 in CREAD2 were randomly assigned in a 1:1 ratio to either placebo or crenezumab. In the final analysis, there were 409 participants in the placebo group and 404 in the crenezumab group in CREAD and 399 in the placebo group and 407 in the crenezumab group in CREAD2. Data were analyzed up until January 2019 and August 2019, respectively. Interventions: Participants received placebo or 60 mg/kg crenezumab intravenously every 4 weeks for up to 100 weeks. Main Outcomes and Measures: The primary outcome was change from baseline to week 105 in Clinical Dementia Rating-Sum of Boxes (CDR-SB) score. Results: There were 813 participants in CREAD (mean [SD] age, 70.7 [8.2] years; 483 female and 330 male) and 806 in CREAD2 (mean [SD] age, 70.9 [7.7] years; 456 female and 350 male). Baseline characteristics were balanced between both groups. The between-group difference in mean change from baseline in CDR-SB score (placebo minus crenezumab) was -0.17 (95% CI, -0.86 to 0.53; P = .63) at week 105 in the CREAD study (88 placebo; 86 crenezumab). Compared with previous trials, no new safety signals were identified, and amyloid-related imaging abnormalities with edema were rare, mild, and transient. No meaningful changes in AD biomarkers were observed. Both studies were discontinued following a preplanned interim analysis indicating that CREAD was unlikely to meet the primary end point. Conclusions and Relevance: Crenezumab was well tolerated but did not reduce clinical decline in participants with early AD. Trial Registration: ClinicalTrials.gov Identifiers: CREAD, NCT02670083; CREAD2, NCT03114657.
Importance: Alzheimer disease (AD), a neurodegenerative disease characterized by β-amyloid plaques and τ tangles in the brain, represents an unmet medical need with no fully approved therapeutics to modify disease progression. Objective: To investigate the safety and efficacy of crenezumab, a humanized monoclonal immunoglobulin G4 antibody targeting β-amyloid oligomers, in participants with prodromal to mild (early) AD. Design, Setting, and Participants: Two phase 3 multicenter randomized double-blind placebo-controlled parallel-group efficacy and safety studies of crenezumab in participants with early AD, CREAD and CREAD2, were initiated in 2016 and 2017, respectively, and were designed to evaluate the efficacy and safety of crenezumab in participants with early AD. CREAD (194 sites in 30 countries) and CREAD2 (209 sites in 27 countries) were global multicenter studies. A total of 3736 and 3664 participants were screened in CREAD and CREAD2, respectively. A total of 3736 and 3664 participants were screened in CREAD and CREAD2, respectively. Both trials enrolled individuals aged 50 to 85 years with early AD. Participants with some comorbidities and evidence of cerebral infarction or more than 4 microbleeds or areas of leptomeningeal hemosiderosis on magnetic resonance imaging were excluded. After 2923 and 2858 were excluded, respectively, 813 participants in CREAD and 806 in CREAD2 were randomly assigned in a 1:1 ratio to either placebo or crenezumab. In the final analysis, there were 409 participants in the placebo group and 404 in the crenezumab group in CREAD and 399 in the placebo group and 407 in the crenezumab group in CREAD2. Data were analyzed up until January 2019 and August 2019, respectively. Interventions: Participants received placebo or 60 mg/kg crenezumab intravenously every 4 weeks for up to 100 weeks. Main Outcomes and Measures: The primary outcome was change from baseline to week 105 in Clinical Dementia Rating-Sum of Boxes (CDR-SB) score. Results: There were 813 participants in CREAD (mean [SD] age, 70.7 [8.2] years; 483 female and 330 male) and 806 in CREAD2 (mean [SD] age, 70.9 [7.7] years; 456 female and 350 male). Baseline characteristics were balanced between both groups. The between-group difference in mean change from baseline in CDR-SB score (placebo minus crenezumab) was -0.17 (95% CI, -0.86 to 0.53; P = .63) at week 105 in the CREAD study (88 placebo; 86 crenezumab). Compared with previous trials, no new safety signals were identified, and amyloid-related imaging abnormalities with edema were rare, mild, and transient. No meaningful changes in AD biomarkers were observed. Both studies were discontinued following a preplanned interim analysis indicating that CREAD was unlikely to meet the primary end point. Conclusions and Relevance: Crenezumab was well tolerated but did not reduce clinical decline in participants with early AD. Trial Registration: ClinicalTrials.gov Identifiers: CREAD, NCT02670083; CREAD2, NCT03114657.
Authors: Sid E O'Bryant; Stephen C Waring; C Munro Cullum; James Hall; Laura Lacritz; Paul J Massman; Philip J Lupo; Joan S Reisch; Rachelle Doody Journal: Arch Neurol Date: 2008-08
Authors: Kelly Posner; Gregory K Brown; Barbara Stanley; David A Brent; Kseniya V Yershova; Maria A Oquendo; Glenn W Currier; Glenn A Melvin; Laurence Greenhill; Sa Shen; J John Mann Journal: Am J Psychiatry Date: 2011-12 Impact factor: 18.112
Authors: Stephen Salloway; Lee A Honigberg; William Cho; Michael Ward; Michel Friesenhahn; Flavia Brunstein; Angelica Quartino; David Clayton; Deborah Mortensen; Tobias Bittner; Carole Ho; Christina Rabe; Stephen P Schauer; Kristin R Wildsmith; Reina N Fuji; Shehnaaz Suliman; Eric M Reiman; Kewei Chen; Robert Paul Journal: Alzheimers Res Ther Date: 2018-09-19 Impact factor: 6.982