Topography and risk factors of amyloid-related imaging abnormality: real-world data from 168 aducanumab-treated patients at a private clinic in South Korea.

INTRODUCTION

Amyloid-related imaging abnormalities (ARIA) are a major safety concern in anti-amyloid therapy for Alzheimer's disease (AD), but real-world data remain limited. We investigated risk factors, temporal characteristics, and spatial distribution of ARIA in aducanumab-treated patients and assessed the safety of apolipoprotein E (APOE) genotype-tailored dosing.

METHODS

We retrospectively analyzed 168 patients with a Clinical Dementia Rating (CDR) of 0.5 to 2 treated with aducanumab between 2022 and 2024. Dosing was individualized by APOE genotype. Serial magnetic resonance imaging (MRI) detected ARIA, multivariable regression identified risk factors, and ARIA with edema or effusion (ARIA-E) lesions were manually segmented to generate topographical maps.

RESULTS

Among 164 patients, 33 (20.1%) developed ARIA-E, with incidence increasing by APOE ε4 status (12.5% non-carriers, 19.5% heterozygotes, 50.0% homozygotes; p = 0.002). Lesions showed posterior predominance. Independent risk factors included APOE ε4 homozygosity, CDR 2, and hypertension. Most cases did not require treatment discontinuation.

DISCUSSION: ARIA-E risk during aducanumab therapy was influenced by genetic and clinical factors, supporting genotype-tailored titration in practice.