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拿阿尔茨海默病患者玩俄罗斯轮盘赌:莱卡奈单抗的认知益处是否超过水肿、中风和脑炎的风险?

Playing Russian Roulette with Alzheimer's Disease Patients: Do the Cognitive Benefits of Lecanemab Outweigh the Risk of Edema, Stroke and Encephalitis?

作者信息

Atwood Craig S, Perry George

机构信息

Geriatric Research, Education and Clinical Center, Veterans Administration Hospital and Department of Medicine, University of Wisconsin, Madison, WI, USA.

Department of Neuroscience, Development and Regenerative Biology, University of Texas at San Antonio, San Antonio, TX, USA.

出版信息

J Alzheimers Dis. 2023;92(3):799-801. doi: 10.3233/JAD-230040.

Abstract

The questionable approval of aducanumab and the recent approval of lecanemab (Leqembi; Eisai and Biogen) by the FDA has raised the issue of safety (stroke, meningitis, and encephalitis) over efficacy (slowing of cognitive decline). This communication recounts the important physiological functions of amyloid-β as a barrier protein with unique sealant and anti-pathogenic activities important for maintaining vascular integrity coupled with innate immune functions that prevent encephalitis and meningitis. The approval of a drug that obviates both of these purposive functions increases the risk of hemorrhage, edema and downstream pathogenic outcomes and should be clearly outlined to patients.

摘要

阿杜卡努单抗的可疑获批以及美国食品药品监督管理局(FDA)近期对仑卡奈单抗(Leqembi;卫材和百健)的批准引发了关于安全性(中风、脑膜炎和脑炎)而非疗效(认知衰退减缓)的问题。本通讯叙述了β淀粉样蛋白作为一种屏障蛋白的重要生理功能,其具有独特的密封和抗病原活性,对于维持血管完整性以及预防脑炎和脑膜炎的固有免疫功能至关重要。批准一种消除这两种目的性功能的药物会增加出血、水肿及下游致病后果的风险,应向患者明确说明。

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