Gantenerumab for early Alzheimer’s disease: a systematic review and meta-analysis

Gantenerumab is a monoclonal antibody targeting amyloid β protein (Aβ) in early Alzheimer’s disease (AD). The authors sought to evaluate gantenerumab safety and efficacy in early AD patients. MEDLINE, Embase, and Cochrane databases were systematically searched until 2 December 2023. Data were examined using the Mantel–Haenszel method and 95% confidence intervals (CIs). Meta-regression analysis was conducted to evaluate a possible link between baseline Clinical Dementia Rating Scale – Sum of Boxes (CDR-SB) and amyloid-related imaging abnormalities (ARIA) at follow-up. R, version 4.2.3, was used for statistical analysis. A total of 4 RCTs and 2848 patients were included, of whom 1580 (55%) received subcutaneous gantenerumab. Concerning clinical scores, the placebo group achieved better rates of change in the Disease Assessment Scale (ADAS-Cog13) (SMD −0.11; 95% CI −0.19– −0.03; <i>p</i> = 0.008569; I² = 0%). Gantenerumab was strongly associated with the occurrence of ARIA-E and ARIA-H: (19.67% vs. 2.31%; RR 9.46; 95% CI 5.55–16.11; <i>p</i> = &lt;0.000001; I² = 10%) and (21.95% vs. 12.38%; RR 1.79; 95% CI 1.50–2.13; <i>p</i> = &lt;0.000001; I² = 0%), respectively. In this meta-analysis, consistent results suggest that gantenerumab is not safe and efficient for early AD, showing no improvement in clinical scores for AD and being associated with the occurrence of ARIA-E and ARIA-H.