Evaluating the Safety and Efficacy of Crenezumab vs Placebo in Adults With Early Alzheimer Disease
Authors: Ostrowitzki Susanne , Bittner Tobias , Sink Kaycee M. , Mackey Howard , Rabe Christina , Honig Lawrence S. , Cassetta Emanuele , Woodward Michael , Boada Mercè , van Dyck Christopher H. , Grimmer Timo , Selkoe Dennis J. , Schneider Andres , Blondeau Kathleen , Hu Nan , Quartino Angelica , Clayton David , Dolton Michael , Dang Yifan , Ostaszewski Beth , Sanabria-Bohórquez Sandra M. , Rabbia Michael , Toth Balazs , Eichenlaub Udo , Smith Jillian , Honigberg Lee A. , Doody Rachelle S. 
Published: September 2022

Importance

Alzheimer disease (AD), a neurodegenerative disease characterized by β-amyloid plaques and τ tangles in the brain, represents an unmet medical need with no fully approved therapeutics to modify disease progression.

Objective

To investigate the safety and efficacy of crenezumab, a humanized monoclonal immunoglobulin G4 antibody targeting β-amyloid oligomers, in participants with prodromal to mild (early) AD.

Design, Setting, and Participants

Two phase 3 multicenter randomized double-blind placebo-controlled parallel-group efficacy and safety studies of crenezumab in participants with early AD, CREAD and CREAD2, were initiated in 2016 and 2017, respectively, and were designed to evaluate the efficacy and safety of crenezumab in participants with early AD. CREAD (194 sites in 30 countries) and CREAD2 (209 sites in 27 countries) were global multicenter studies. A total of 3736 and 3664 participants were screened in CREAD and CREAD2, respectively. A total of 3736 and 3664 participants were screened in CREAD and CREAD2, respectively. Both trials enrolled individuals aged 50 to 85 years with early AD. Participants with some comorbidities and evidence of cerebral infarction or more than 4 microbleeds or areas of leptomeningeal hemosiderosis on magnetic resonance imaging were excluded. After 2923 and 2858 were excluded, respectively, 813 participants in CREAD and 806 in CREAD2 were randomly assigned in a 1:1 ratio to either placebo or crenezumab. In the final analysis, there were 409 participants in the placebo group and 404 in the crenezumab group in CREAD and 399 in the placebo group and 407 in the crenezumab group in CREAD2. Data were analyzed up until January 2019 and August 2019, respectively.

Interventions

Participants received placebo or 60 mg/kg crenezumab intravenously every 4 weeks for up to 100 weeks.

Main Outcomes and Measures

The primary outcome was change from baseline to week 105 in Clinical Dementia Rating–Sum of Boxes (CDR-SB) score.

Results

There were 813 participants in CREAD (mean [SD] age, 70.7 [8.2] years; 483 female and 330 male) and 806 in CREAD2 (mean [SD] age, 70.9 [7.7] years; 456 female and 350 male). Baseline characteristics were balanced between both groups. The between-group difference in mean change from baseline in CDR-SB score (placebo minus crenezumab) was −0.17 (95% CI, −0.86 to 0.53; P = .63) at week 105 in the CREAD study (88 placebo; 86 crenezumab). Compared with previous trials, no new safety signals were identified, and amyloid-related imaging abnormalities with edema were rare, mild, and transient. No meaningful changes in AD biomarkers were observed. Both studies were discontinued following a preplanned interim analysis indicating that CREAD was unlikely to meet the primary end point.

Conclusions and Relevance

Crenezumab was well tolerated but did not reduce clinical decline in participants with early AD.

Trial Registration

ClinicalTrials.gov Identifiers: CREAD, NCT02670083; CREAD2, NCT03114657