Publications & Posters

Comparing progression biomarkers in clinical trials of early Alzheimer’s disease

ANNALS OF CLINICAL AND TRANSLATIONAL NEUROLOGY | AUGUST 11, 2020

Cullen NC, Zetterberg H, Insel PS, Olsson B, Andreasson U, Blennow K, Hansson O and Mattsson-Carlgren N.

Ann Clin Transl Neurol. 2020 Aug 11

DOI: https://doi.org/10.1002/acn3.51158

ABSTRACT

OBJECTIVE

To investigate the statistical power of plasma, imaging, and cognition biomarkers as Alzheimer’s disease (AD) clinical trial outcome measures.

METHODS

Plasma neurofilament light, structural magnetic resonance imaging, and cognition were measured longitudinally in the Alzheimer’s Disease Neuroimaging Initiative (ADNI) in control (amyloid PET or CSF Aβ42 negative [Aβ‐] with Clinical Dementia Rating scale [CDR] = 0; n = 330), preclinical AD (Aβ + with CDR = 0; n = 218) and mild AD (Aβ + with CDR = 0.5‐1; n = 697) individuals. A statistical power analysis was performed across biomarkers and groups based on longitudinal mixed effects modeling and using several different clinical trial designs.

RESULTS

For a 30‐month trial of preclinical AD, both the temporal composite and hippocampal volumes were superior to plasma neurofilament light and cognition. For an 18‐month trial of mild AD, hippocampal volume was superior to all other biomarkers. Plasma neurofilament light became more effective with increased trial duration or sampling frequency. Imaging biomarkers were characterized by high slope and low within‐subject variability, while plasma neurofilament light and cognition were characterized by higher within‐subject variability.

INTERPRETATION

MRI measures had properties that made them preferable to cognition and pNFL as outcome measures in clinical trials of early AD, regardless of cognitive status. However, pNfL and cognition can still be effective depending on inclusion criteria, sampling frequency, and response to therapy. Future trials will help to understand how sensitive pNfL and MRI are to detect downstream effects on neurodegeneration of drugs targeting amyloid and tau pathology in AD.