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Reply: REPLY: 2. Cummings J, Rabinovici GD, Atri A, et al. Aducanumab: appropriate use recommendations update. JPrev Alzheimers Dis 2021;8:398–410 CrossRef Medline n the commentary “MRI Monitoring of Anti-Alzheimer ITherapy Amyloid-Related Imaging Abnormalities: Due P.M. Cogswell Diligence or Overkill?” Høilund-Carlsen et al provide their C.R. Jack, Jr. viewpoint on the efficacy of monoclonal antibody therapies Department of Radiology Mayo Clinic (mAbs) targeting beta-amyloid and the appropriate imaging for Rochester, Minnesota treatment monitoring and assessment of outcomes. Drug effi- cacy and drug safety have been assessed via multiple metrics in J.A. Barakos Department of Radiology clinical trials of anti-amyloid therapies. Assessment of drug effi- California Pacific Medical Center cacy is a matter of clinical trial design, which we did not address San Francisco, California in our review. Amyloid-related imaging abnormalities (ARIA) are one of the many safety metrics assessed and used to deter- F. Barkhof Departments of Radiology and Nuclear Medicine mine eligibility for continued dosing; their presence may require VU University Medical Center temporary suspension or permanent discontinuation of drug Amsterdam, the Netherlands dosing. Queen Square Institute of Neurology and Centre for Medical Image Computing University College Regarding the appropriate imaging assessment of patients London, UK undergoing therapy, we limited the scope of our review to MR imaging assessment of patients before and during anti-amyloid T.S. Benzinger mAb therapy. We did not address the role of PET in clinical Departments of Radiology and Neurosurgery Washington University School of Medicine trials or the potential role of PET in clinical practice. Further St. Louis, Missouri discussion of PET is warranted and may include amyloid PET for pre- or posttreatment evaluation, as has been used in clinical C.A. Raji Departments of Radiology and Neurology trials, and FDG-PET for assessment of functional outcomes, as Washington University School of Medicine proposed by Høilund-Carlsen et al. In the future, it may be help- St. Louis, Missouri ful for individuals designing clinical trials to consider functional T.Y. Poussaint elements in the imaging assessment of patients before and dur- Department of Radiology ing mAbs therapy. When mAbs targeting beta-amyloid become Boston Children’s Hospital clinically available, it will be important for the community to Boston, Massachusetts consider the expanded use of PET in addition to MR for imaging V.K. Ramanan assessment. Department of Neurology Mayo Clinic Rochester, Minnesota REFERENCES 1. Cogswell PM, Barakos JA, Barkhof F, et al. Amyloid-related imaging C.T. Whitlow Departments of Radiology and Biomedical Engineering abnormalities with emerging Alzheimer disease therapeutics: detec- Wake Forest School of Medicine tion and reporting recommendations for clinical practice. AJNR Am J Winston-Salem, North Carolina Neuroradiol 2022;43:E19–E35 CrossRef Medline http://dx.doi.org/10.3174/ajnr.A7731 E6 Letters 2023 www.ajnr.org http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

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Publisher
American Journal of Neuroradiology
Copyright
© 2023 by American Journal of Neuroradiology
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.a7731
Publisher site
See Article on Publisher Site

Abstract

REPLY: 2. Cummings J, Rabinovici GD, Atri A, et al. Aducanumab: appropriate use recommendations update. JPrev Alzheimers Dis 2021;8:398–410 CrossRef Medline n the commentary “MRI Monitoring of Anti-Alzheimer ITherapy Amyloid-Related Imaging Abnormalities: Due P.M. Cogswell Diligence or Overkill?” Høilund-Carlsen et al provide their C.R. Jack, Jr. viewpoint on the efficacy of monoclonal antibody therapies Department of Radiology Mayo Clinic (mAbs) targeting beta-amyloid and the appropriate imaging for Rochester, Minnesota treatment monitoring and assessment of outcomes. Drug effi- cacy and drug safety have been assessed via multiple metrics in J.A. Barakos Department of Radiology clinical trials of anti-amyloid therapies. Assessment of drug effi- California Pacific Medical Center cacy is a matter of clinical trial design, which we did not address San Francisco, California in our review. Amyloid-related imaging abnormalities (ARIA) are one of the many safety metrics assessed and used to deter- F. Barkhof Departments of Radiology and Nuclear Medicine mine eligibility for continued dosing; their presence may require VU University Medical Center temporary suspension or permanent discontinuation of drug Amsterdam, the Netherlands dosing. Queen Square Institute of Neurology and Centre for Medical Image Computing University College Regarding the appropriate imaging assessment of patients London, UK undergoing therapy, we limited the scope of our review to MR imaging assessment of patients before and during anti-amyloid T.S. Benzinger mAb therapy. We did not address the role of PET in clinical Departments of Radiology and Neurosurgery Washington University School of Medicine trials or the potential role of PET in clinical practice. Further St. Louis, Missouri discussion of PET is warranted and may include amyloid PET for pre- or posttreatment evaluation, as has been used in clinical C.A. Raji Departments of Radiology and Neurology trials, and FDG-PET for assessment of functional outcomes, as Washington University School of Medicine proposed by Høilund-Carlsen et al. In the future, it may be help- St. Louis, Missouri ful for individuals designing clinical trials to consider functional T.Y. Poussaint elements in the imaging assessment of patients before and dur- Department of Radiology ing mAbs therapy. When mAbs targeting beta-amyloid become Boston Children’s Hospital clinically available, it will be important for the community to Boston, Massachusetts consider the expanded use of PET in addition to MR for imaging V.K. Ramanan assessment. Department of Neurology Mayo Clinic Rochester, Minnesota REFERENCES 1. Cogswell PM, Barakos JA, Barkhof F, et al. Amyloid-related imaging C.T. Whitlow Departments of Radiology and Biomedical Engineering abnormalities with emerging Alzheimer disease therapeutics: detec- Wake Forest School of Medicine tion and reporting recommendations for clinical practice. AJNR Am J Winston-Salem, North Carolina Neuroradiol 2022;43:E19–E35 CrossRef Medline http://dx.doi.org/10.3174/ajnr.A7731 E6 Letters 2023 www.ajnr.org

Journal

American Journal of Neuroradiology – American Journal of Neuroradiology

Published: Jan 1, 2023

References

  • Amyloid-related imaging abnormalities with emerging Alzheimer disease therapeutics: detection and reporting recommendations for clinical practice
    PM. Cogswell; JA. Barakos; F. Barkhof
  • Aducanumab: appropriate use recommendations update
    J. Cummings; GD. Rabinovici; A. Atri