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Panelists highlight prevention trials testing antibodies years before symptoms appear
Summary
Speakers including Dr. Reisa Sperling outlined the move from symptomatic treatment to secondary and primary prevention trials (A4, AHEAD A3/A45, Trailblazer) and argued earlier intervention may yield greater benefit; they cautioned that meaningful population-level screening requires effective, available treatments.
Dr. Reisa Sperling told the council the research field has shifted earlier on the disease continuum and that several large prevention trials are underway or maturing. She reviewed the A4 trial and its lessons, described the AHEAD program (a3/a45 cohorts) testing lecanemab in earlier stages, and mentioned trials like Trailblazer (donanemab) that aim to prevent progression to MCI in biomarker-positive, asymptomatic people. Sperling emphasized that the amount of pathology (measured in centiloids or pTau levels) matters for expected treatment effect and that individuals with lower baseline pathology often derive larger sustained benefit in subgroup analyses.
Sperling and other researchers urged careful staging and biomarker-informed enrollment in prevention trials, and discussed endpoints (cognitive outcomes, amyloid/tau PET, blood biomarker trajectories). "We can detect Alzheimer's disease in the brain 10 years before people have impairment," she said, arguing that validated biomarkers plus effective therapies could justify earlier testing and intervention. At the same time, the panel agreed that until prevention trials produce positive, actionable results for asymptomatic people, routine population screening in primary care would be premature; instead, they recommended continued trial enrollment and infrastructure investment to make prevention feasible and equitable.
