by Viktoria Papp
Each month the eanNews editorial team reviews the scientific press for recently published papers of outstanding interest to neurologists. Below we present our selection for December 2024.
1) Optimal timing of anticoagulation after acute ischaemic stroke with atrial fibrillation (OPTIMAS): a multicentre, blinded-endpoint, phase 4, randomised controlled trial | The Lancet
The data obtained by this phase 4 British study tested the current approach of delaying direct oral anticoagulants (DOAC) treatment after ischaemic stroke in patients with atrial fibrillation. The primary endpoint was the composite of the incidence of recurrent ischaemic stroke, symptomatic intracranial haemorrhage, unclassifiable stroke, or systemic embolism within 90 days in a modified intention-to-treat group. Results from the 3621 patients who completed the study showed that early DOAC initiation within 4 days versus delayed initiation between 7 and 14 days had no difference in the primary endpoint and in particular in the frequency of symptomatic intracranial haemorrhage. These findings demonstrate that there is no rationale for delaying the initiation of DOACs after an ischaemic stroke in patients with atrial fibrillation.
2) Changes in Alzheimer Disease Blood Biomarkers and Associations With Incident All-Cause Dementia | JAMA
This study looked for associations between temporal changes in biomarkers from midlife to late-life and the development of dementias. Prospectively collected blood samples from the participants’ midlife and late-life stages were analysed for Alzheimer’s disease (AD)–specific biomarkers, neurofilament light (NfL) and glial fibrillary acid protein (GFAP). In total, 252 (16.5%) out of 1525 participants developed dementia. The effects of several midlife risk factors on the plasma level of these biomarkers were also considered. Results revealed only long-term associations between AD-specific biomarkers in midlife and late-life dementia. All biomarkers in late-life showed association with late-life dementia.
3) Amyloid-Related Imaging Abnormalities (ARIA) in Clinical Trials of Gantenerumab in Early Alzheimer Disease | JAMA
Amyloid-related imaging abnormalities (ARIA) are the most challenging side effect of antibody treatments against amyloid-beta (Aβ) in Alzheimer´s disease. The goal of this study was to identify risk factors and new features of ARIA and to better understand its long-term effects on cognition. The study utilised data from two previous phase 3 studies (GRADUATE I/II) in which gantenerumab, a fully human IgG1 antibody against Aβ, was assessed in early symptomatic Alzheimer’s disease (AD). MRI data from 1939 patients suggest that the severity of AD-related Aβ neuropathology and comorbid cerebrovascular pathology are baseline risk factors for ARIA to be aware of when a patient is treated with anti-Aβ monoclonal antibody treatment. No significant long-term effect on cognitive functions was observed at the group level.
