Prognostic value of plasma biomarkers for informing clinical trial design in mild-to-moderate Alzheimer’s disease
Abstract Background Emerging evidence supports the diagnostic and prognostic utility of plasma biomarkers in Alzheimer’s disease (AD), particularly in early disease stages. We sought to extend these findings by evaluating the prognostic value of plasma biomarkers in a clinical trial of mild-to-moder...
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BMC
2025-05-01
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| Series: | Alzheimer’s Research & Therapy |
| Online Access: | https://doi.org/10.1186/s13195-025-01745-3 |
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| author | Yuqi Qiu Diane M. Jacobs Karen Messer David P. Salmon Cheryl L. Wellington Sophie Stukas Carolyn Revta James B. Brewer Gabriel C. Léger Brianna Askew Lia Donahue Stephen Kaplita Vladimir Coric Irfan A. Qureshi Howard H. Feldman The Alzheimer’s Disease Cooperative Study T2 Protect AD Study Group |
| author_facet | Yuqi Qiu Diane M. Jacobs Karen Messer David P. Salmon Cheryl L. Wellington Sophie Stukas Carolyn Revta James B. Brewer Gabriel C. Léger Brianna Askew Lia Donahue Stephen Kaplita Vladimir Coric Irfan A. Qureshi Howard H. Feldman The Alzheimer’s Disease Cooperative Study T2 Protect AD Study Group |
| author_sort | Yuqi Qiu |
| collection | DOAJ |
| description | Abstract Background Emerging evidence supports the diagnostic and prognostic utility of plasma biomarkers in Alzheimer’s disease (AD), particularly in early disease stages. We sought to extend these findings by evaluating the prognostic value of plasma biomarkers in a clinical trial of mild-to-moderate AD. Methods Post-hoc analyses investigated whether baseline concentrations of plasma biomarkers (Aβ42/Aβ40, T-tau, P-tau181, NfL, and GFAP) predicted change in ADAS-Cog11, CDR-SB, and volumetric MRI among participants in T2 Protect AD, a negative 48-week, phase-2, placebo-controlled trial of troriluzole in mild-to-moderate AD. All trial participants met diagnostic criteria for probable AD. Baseline concentrations of, and 48-week changes in, plasma biomarkers were assessed for association with 48-week change in outcomes using linear regression. Combinations of baseline biomarkers that best predicted change on the ADAS-Cog11 and CDR-SB were identified using least absolute shrinkage and selection operator (LASSO) regression. Biomarker-informed sample size calculations were modeled. Results Of 350 trial participants, 319 had all requisite biomarker and clinical outcome data for inclusion in these analyses (mean age 71.5, SD = 8.03; 58.6% female). Higher plasma NfL at baseline predicted worsening scores on the ADAS-Cog11 (effect size (ES) = 1.42, 95%CI = [0.43, 2.41], p = 0.026) and CDR-SB (ES = 0.42, 95%CI = [0.10, 0.73], p = 0.048). LASSO regression revealed that worsening on the ADAS-Cog11 was best predicted by the combination of baseline plasma NfL, T-tau, and Aβ42/40 ratio, whereas baseline NfL alone best predicted worsening on CDR-SB. Higher baseline NfL predicted increasing ventricular volume (ES = 1.30cm3, 95%CI = [0.43, 2.17], p = 0.018) and decreasing mid-temporal cortical volume (ES = -0.47, 95%CI = [-0.74, -0.20], p = 0.003). Increasing NfL over the 48-week trial was associated with worsening on CDR-SB but not ADAS-Cog11. Modeling of biomarker-informed power calculations revealed that including high NfL as a trial entry criterion could substantially reduce requisite trial sample size. Conclusions Elevated baseline plasma NfL predicted more rapid clinical decline and MRI volume loss. Furthermore, increasing plasma NfL concentration over time was associated with worsening on the CDR-SB. Plasma NfL is an easily accessible biomarker that may enhance the design of clinical trials in mild-to-moderate AD. Trial registration The T2 Protect AD trial was registered as NCT03605667 on clinicaltrials.gov on 2018-07-27. |
| format | Article |
| id | doaj-art-5e69a20ce7ab4187aaa26bcdb393d543 |
| institution | DOAJ |
| issn | 1758-9193 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Alzheimer’s Research & Therapy |
| spelling | doaj-art-5e69a20ce7ab4187aaa26bcdb393d5432025-08-20T02:55:31ZengBMCAlzheimer’s Research & Therapy1758-91932025-05-0117111410.1186/s13195-025-01745-3Prognostic value of plasma biomarkers for informing clinical trial design in mild-to-moderate Alzheimer’s diseaseYuqi Qiu0Diane M. Jacobs1Karen Messer2David P. Salmon3Cheryl L. Wellington4Sophie Stukas5Carolyn Revta6James B. Brewer7Gabriel C. Léger8Brianna Askew9Lia Donahue10Stephen Kaplita11Vladimir Coric12Irfan A. Qureshi13Howard H. Feldman14The Alzheimer’s Disease Cooperative Study T2 Protect AD Study Group15KLATASDS-MOE, School of Statistics, East China Normal UniversityDepartment of Neurosciences, School of Medicine, University of California San DiegoDivision of Biostatistics and Bioinformatics, Herbert Wertheim School of Public Health, University of California San DiegoDepartment of Neurosciences, School of Medicine, University of California San DiegoDepartment of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British ColumbiaDepartment of Pathology and Laboratory Medicine, Djavad Mowafaghian Centre for Brain Health, University of British ColumbiaAlzheimer’s Disease Cooperative Study, University of California San DiegoDepartment of Neurosciences, School of Medicine, University of California San DiegoDepartment of Neurosciences, School of Medicine, University of California San DiegoAlzheimer’s Disease Cooperative Study, University of California San DiegoBiohaven Pharmaceuticals, IncBiohaven Pharmaceuticals, IncBiohaven Pharmaceuticals, IncBiohaven Pharmaceuticals, IncDepartment of Neurosciences, School of Medicine, University of California San DiegoKLATASDS-MOE, School of Statistics, East China Normal UniversityAbstract Background Emerging evidence supports the diagnostic and prognostic utility of plasma biomarkers in Alzheimer’s disease (AD), particularly in early disease stages. We sought to extend these findings by evaluating the prognostic value of plasma biomarkers in a clinical trial of mild-to-moderate AD. Methods Post-hoc analyses investigated whether baseline concentrations of plasma biomarkers (Aβ42/Aβ40, T-tau, P-tau181, NfL, and GFAP) predicted change in ADAS-Cog11, CDR-SB, and volumetric MRI among participants in T2 Protect AD, a negative 48-week, phase-2, placebo-controlled trial of troriluzole in mild-to-moderate AD. All trial participants met diagnostic criteria for probable AD. Baseline concentrations of, and 48-week changes in, plasma biomarkers were assessed for association with 48-week change in outcomes using linear regression. Combinations of baseline biomarkers that best predicted change on the ADAS-Cog11 and CDR-SB were identified using least absolute shrinkage and selection operator (LASSO) regression. Biomarker-informed sample size calculations were modeled. Results Of 350 trial participants, 319 had all requisite biomarker and clinical outcome data for inclusion in these analyses (mean age 71.5, SD = 8.03; 58.6% female). Higher plasma NfL at baseline predicted worsening scores on the ADAS-Cog11 (effect size (ES) = 1.42, 95%CI = [0.43, 2.41], p = 0.026) and CDR-SB (ES = 0.42, 95%CI = [0.10, 0.73], p = 0.048). LASSO regression revealed that worsening on the ADAS-Cog11 was best predicted by the combination of baseline plasma NfL, T-tau, and Aβ42/40 ratio, whereas baseline NfL alone best predicted worsening on CDR-SB. Higher baseline NfL predicted increasing ventricular volume (ES = 1.30cm3, 95%CI = [0.43, 2.17], p = 0.018) and decreasing mid-temporal cortical volume (ES = -0.47, 95%CI = [-0.74, -0.20], p = 0.003). Increasing NfL over the 48-week trial was associated with worsening on CDR-SB but not ADAS-Cog11. Modeling of biomarker-informed power calculations revealed that including high NfL as a trial entry criterion could substantially reduce requisite trial sample size. Conclusions Elevated baseline plasma NfL predicted more rapid clinical decline and MRI volume loss. Furthermore, increasing plasma NfL concentration over time was associated with worsening on the CDR-SB. Plasma NfL is an easily accessible biomarker that may enhance the design of clinical trials in mild-to-moderate AD. Trial registration The T2 Protect AD trial was registered as NCT03605667 on clinicaltrials.gov on 2018-07-27.https://doi.org/10.1186/s13195-025-01745-3 |
| spellingShingle | Yuqi Qiu Diane M. Jacobs Karen Messer David P. Salmon Cheryl L. Wellington Sophie Stukas Carolyn Revta James B. Brewer Gabriel C. Léger Brianna Askew Lia Donahue Stephen Kaplita Vladimir Coric Irfan A. Qureshi Howard H. Feldman The Alzheimer’s Disease Cooperative Study T2 Protect AD Study Group Prognostic value of plasma biomarkers for informing clinical trial design in mild-to-moderate Alzheimer’s disease Alzheimer’s Research & Therapy |
| title | Prognostic value of plasma biomarkers for informing clinical trial design in mild-to-moderate Alzheimer’s disease |
| title_full | Prognostic value of plasma biomarkers for informing clinical trial design in mild-to-moderate Alzheimer’s disease |
| title_fullStr | Prognostic value of plasma biomarkers for informing clinical trial design in mild-to-moderate Alzheimer’s disease |
| title_full_unstemmed | Prognostic value of plasma biomarkers for informing clinical trial design in mild-to-moderate Alzheimer’s disease |
| title_short | Prognostic value of plasma biomarkers for informing clinical trial design in mild-to-moderate Alzheimer’s disease |
| title_sort | prognostic value of plasma biomarkers for informing clinical trial design in mild to moderate alzheimer s disease |
| url | https://doi.org/10.1186/s13195-025-01745-3 |
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