TRAILBLAZER-ALZ 4: direct comparison of donanemab and aducanumab

Stephen P. Salloway, MD, MS, Butler Hospital & Warren Alpert Medical School of Brown University, Providence, RI, discusses the main outcomes of the TRAILBLAZER-ALZ 4 trial (NCT05108922). This trial is unique in directly comparing two anti-amyloid monoclonal antibodies in the same study: donanemab and aducanumab. Key findings included the degree of amyloid lowering at 6 months, which was significantly higher with donanemab than aducanumab (37.9% vs. 1.6% clearance rates, respectively). Substantial amyloid lowering differences at this time could be because of the faster titration of donanemab. The rate of amyloid related imaging abnormalities (ARIA) was similar between the two drugs. Donanemab was also shown to significantly decrease plasma p-tau 217, which indicates the potential of p-tau 217 as a marker for treatment response. Further results are expected at 12- and 18-months of the trial, when the patients receiving aducanumab will have reached a higher exposure to the drug. This interview took place at the AD/PD™ 2023 congress in Gothenburg, Sweden.
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