Gantenerumab May Delay Alzheimer Disease Symptoms in High-Risk Adults: Daily Dose

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On March 21, 2025, we reported on a study published in The Lancet Neurology that examined the safety and efficacy of long-term treatment with high doses of gantenerumab, an experimental anti-amyloid drug, in dominantly inherited Alzheimer disease.

The study

Researchers conducted a 3-year open-label extension (OLE) study of the Dominantly Inherited Alzheimer Network Trials Unit (DIAN-TU) clinical trial. The DIAN-TU study is an ongoing research platform trial examining the safety and efficacy of multiple investigational treatments in people with dominantly inherited Alzheimer's disease (DIAD). Data showed that gantenerumab was effective in removing amyloid plaques and had other positive biological effects in the brain.

The current OLE study used high doses of gantenerumab (up to 1500 mg every 2 weeks) over 3 years. Investigators examined 73 asymptomatic adults with DIAD who were treated with gantenerumab in either the double-blind or high-dose open-label extension phase of the ongoing DIAN-TU-001 trial.

The findings

Analysis of clinical decline using the Clinical Dementia Rating-Sum of Boxes showed a hazard ratio of 0.79 (95% CI 0.47 to 1.32) for asymptomatic DIAD participants treated with gantenerumab at any stage of the study. For the 22 participants who received gantenerumab for the longest period, a mean of 8 years, the HR for clinical decline was 0.53 (95% CI 0.27 to 1.03).

After a median 2.6 years of treatment, the adjusted mean change in standardized uptake value ratio (SUVR) on amyloid PET was -0.71 (95% CI -0.88 to -0.53, P < .0001), a confirmation of significant amyloid reduction. Amyloid-related imaging abnormalities (ARIA) occurred in 53% of participants; most were asymptomatic. No treatment-associated macrohemorrhages or deaths occurred.

Authors' comments

"Partial or short-term amyloid removal did not show significant clinical effects. However, long-term full amyloid removal potentially delayed symptom onset and dementia progression. Our conclusions are limited due to the OLE design and use of external controls and need to be confirmed in long-term trials."

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