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AD/PD 2026 | Risk of ARIA in APOE4/4 AD and insights from the APOLLOE4 trial of valiltramiprosate

David Watson, PsyD, Alzheimer’s Research and Treatment Center, Wellington, FL, discusses the risk of amyloid-related imaging abnormalities (ARIA) associated with amyloid-targeting antibodies in individuals with APOE4/4 Alzheimer’s disease (AD). Dr Watson shares that the Phase III APOLLOE4 trial (NCT04770220) found no ARIA safety concerns in individuals treated with valiltramiprosate. This interview took place at the AD/PD™ 2026 International Conference on Alzheimer’s and Parkinson’s Diseases in Copenhagen, Denmark.

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Transcript

So valiltramiprosate, and, you know, one of the things that’s fascinating about this is that we’re seeing and looking at the data is, to begin with, in a homozygote patient who’s APOE4-4, the risk factors with ARIA-E and ARIA-H resulting from monoclonal antibody usage that we currently have within the DMT trials and on commercial availability is there’s a significantly higher risk factor for ARIA-E and ARIA-H...

So valiltramiprosate, and, you know, one of the things that’s fascinating about this is that we’re seeing and looking at the data is, to begin with, in a homozygote patient who’s APOE4-4, the risk factors with ARIA-E and ARIA-H resulting from monoclonal antibody usage that we currently have within the DMT trials and on commercial availability is there’s a significantly higher risk factor for ARIA-E and ARIA-H. And in this particular trial, we actually saw zero safety concerns with ARIA-E and ARIA-H. And in fact, in looking at this post hoc, there may actually be some protective benefits because we do see smaller numbers, but we do see, looking at the, you know, post hoc post hoc analysis, an actual reduction in ARIA-E and ARIA-H for those on actual study drug versus those that were on placebo, you know, about 50% reduction, which is quite remarkable and interesting to really evaluate that further. But this is more upstream and works, you know, would work very well in combination, in my opinion, perhaps offering some protective benefit, but more importantly, you know, trying to address, you know, individuals that are afflicted with this really in, you know, kind of stage four. We’d love to see it, obviously, a little bit earlier in stage three and kind of even, you know, pre-symptomatic would be wonderful in the future, but we’re obviously not there yet. You know, and working in combination with the monoclonal antibody, I think this particular agent would be very beneficial.

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