This transcript has been edited for clarity.
Dear Colleagues, I am Christoph Diener from the University of Duisburg-Essen, Germany. The goal of my video this month is to summarize the most important clinical studies in neurology published in 2022.
Warnings about lecanemab
I would like to begin by discussing a publication in The New England Journal of Medicine on Alzheimer’s disease.
This study investigated lecanemab, a monoclonal antibody against beta-amyloid in people with mild cognitive impairment or early Alzheimer’s disease. Results showed that a monoclonal antibody against beta-amyloid was effective on both primary and secondary endpoints of cognition and function.
The data on amyloid on PET were most impressive. The amyloid burden in the brain remained unchanged in placebo-treated patients. However, the monoclonal antibody treatment group reduced brain amyloid concentrations by 60% to 70% within 18 months.
At present, we do not know how this translates into clinical benefit over the years. But the most important message here is that for the first time in history, we have a drug that slows the progression of early Alzheimer’s disease. .
There are also warnings that are adverse event profiles. These monoclonal antibodies can cause brain edema, requiring an MRI every three months. It can also cause minor bleeding, which is usually asymptomatic. No one knows what will happen to patients who need anticoagulant therapy because they have atrial fibrillation and who take these drugs for a long period of time.
COVID-19 and physical symptoms
Let’s move on to the post-COVID-19 setting.
We are currently conducting a number of studies looking at people who have and are in control of COVID-19 and who are being monitored for physical symptoms. Most of the physical symptoms are in the neurological realm. Headache, fatigue, dizziness, back pain, muscle pain, and nausea.
One of the studies in the Netherlands examined the post-COVID-19 state while correcting for individual symptoms that existed before COVID-19 and the symptom dynamics of the SARS-CoV-2-free population during the pandemic. It is the first to report the nature and prevalence. About 20% of people infected with COVID-19 developed physical symptoms 90 to 150 days after infection, compared to only 9% of controls.
Unfortunately, the pathophysiology of this post-COVID-19 syndrome is unknown and there are no real effective treatments.
Need for new sleeping pills
Now let’s move on to sleep disorders.
We used to have benzodiazepines, but they have been replaced by the Z substance. Although Substance Z was not thought to lead to addiction, some patients have become addicted.
A new class of drugs is the orexin antagonists. Daridorexant is a dual orexin antagonist that has shown efficacy in two large Phase 3 trials. The good news here is that not only did the drug improve the latency for patients to fall asleep, but it also had no hangover effect the next day.
Epstein-Barr virus and multiple sclerosis
The most controversial aspect of multiple sclerosis research came from a large study using the Veterans Administration database. Epstein-Barr virus infection was shown to significantly increase the risk of developing multiple sclerosis. In contrast, this was not the case for cytomegalovirus virus.
Unfortunately, 70% to 80% of adults are infected with the Epstein-Barr virus, making it a very common infection. To date there is no vaccine, and it remains unknown whether vaccines really reduce the chances of multiple sclerosis.
Parkinson’s disease treatment hits roadblocks
Let’s move on to Parkinson’s disease.
We know that α-synuclein aggregates in the brain are a clear pathophysiological factor in this disease. A group in Kiel, Germany, has developed a blood test that identifies alpha-synuclein in serum. That’s good news.
The bad news is that two randomized, placebo-controlled trials in early-stage Parkinson’s disease patients using monoclonal antibodies to alpha-synuclein were negative. This means that there are currently no treatments with disease-modifying effects for Parkinson’s disease.
Mechanical thrombectomy turns out to be superior in stroke
Regarding stroke, we have two important updates.
Several randomized studies have shown that the addition of thrombolytic therapy to precirculatory mechanical thrombectomy improves functional outcomes, reduces mortality, and increases reperfusion rates.
We are currently conducting two randomized trials that clearly show that mechanical thrombectomy is superior to pure medical treatment in people with thrombosis or occlusion of the basilar artery.
A step forward in migraine prophylaxis
Headache at the end.
The good news here is that monoclonal antibodies against CGRP or CGRP receptors are effective in treating chronic migraine. It is also effective for people who have failed previous treatments and for people with medication-overuse headaches. Also, there are almost no side effects.
Besides being costly, this is a step forward in the specific treatment of migraine from a prophylactic therapy perspective.
Colleagues, 2022 has been an exciting year. These are just some of the highlights. Thank you very much for watching and listening.
See you in 2023!
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