Introduktion: Alzheimers sjukdom är en neurodegenerativ sjukdom som orsakas av ansamling av amyloid-β (Aβ) i hjärnan. Prevalensen av Alzheimers sjukdom ökar, och symtom inkluderar minnesförlust, ångest, depression, förvirring, nedsatt omdöme och desorientering. Ålder och genetiska varianter är två riskfaktorer för att utveckla Alzheimers sjukdom. Det finns två modeller som förklarar hur sjukdomen kan uppstå, 1) den amyloida hypotesen som beskriver hur deposition av Aβ leder till ökad aggregation av proteinet tau vilket orsakar celldöd och neurodegeneration, och 2) den kolinerga hypotesen vilken beskriver att Aβ-plack minskar produktionen av acetylkolin vilket leder minskad aktivitet i kolinerga nerver. Det är främst entorhinala cortex och hippocampus som drabbas. Diagnostisering görs genom medicinska och neurologiska undersökningar och genom standardiserade test/instrument. I dagläget kan symtom av Alzheimers sjukdom behandlas med acetylkolinesterasinhibitorer och memantin. Ett annat behandlingssätt är att använda monoklonala antikroppar som riktats mot Aβ för att minska belastningen av Aβ i hjärnan. För att bedöma effekt av sådana läkemedel används bedömningsmetoder baserade på kognitiva och funktionella tester.  Syfte: Syftet med detta arbete var att undersöka effektivitet och säkerhet av anti-Aβ antikroppar för behandling av Alzheimers sjukdom, vilket gjordes genom att analysera kognitiv förmåga, biomarkörer och biverkningar.  Metod: Detta arbete är en litteraturstudie som baserades på fem läkemedelsstudier vilka erhölls från databasen PubMed. Sökord som användes vid litteratursökning var ”aducanumab”, ”lecanemab”, ”donanemab”, ”crenezumab” och ”bapineuzumab”.  Resultat: Hög dos aducanumab i studien EMERGE och lecanemab visade statistiskt signifikant förändring på alla utfallsvariabler, och analys av biomarkörer visade minskad amyloid-belastning i hjärnan. Donanemab visade statistiskt signifikant skillnad på den primära utfallsvariabeln och på analys av biomarkörer, men resultat på sekundära utfallsvariabler var inte statistiskt signifikanta. Crenezumab visade endast statistiskt signifikant förändring på den primära utfallsvariabeln i CREAD2. Bapineuzumab visade ingen statistiskt signifikant skillnad på någon utfallsvariabel eller på förändringar i biomarkörer. De resultat som var statistiskt signifikanta indikerade minskad kognitiv försämring hos patienterna. ARIA var en vanlig biverkning hos alla läkemedel utom crenezumab, men förekomsten av ARIA var i de flesta fall mild till måttlig. Andra vanliga biverkningar inkluderade infusionsrelaterade reaktioner, huvudvärk och fall.  Slutsats: Baserat på resultaten från detta arbete dras slutsatsen att aducanumab, lecanemab och donanemab var de läkemedel med högst effektivitet. Framtiden ser mest lovande ut för aducanumab och lecanemab med anledning av positiva resultat på primära och sekundära utfallsvariabler och biomarkörer samt FDAs godkännande av läkemedlen i USA. Förekomsten av ARIA påverkar säkerheten av läkemedlen och därför behöver fler studier genomföras för att undersöka deras säkerhet ytterligare. / Background: Alzheimer’s disease is a neurodegenerative disease that is caused by accumulation of amyloid-β (Aβ) in the brain. The prevalence of Alzheimer’s disease is increasing, and symptoms of the disease include memory loss, anxiety, depression, confusion, impaired judgment and disorientation. Age and genetic variants are the two main risk factors for developing Alzheimer’s disease. There are two models which describe the development of the disease, 1) the amyloid hypothesis which describes how the deposition of Aβ leads to increased aggregation of the protein tau, which causes neuronal cell death and neurodegeneration, and 2) the cholinergic hypothesis which describes that Aβ plaques decrease the production of acetylcholine, this causes less activity in cholinergic neurons. The two areas in the brain which are mainly affected by neurodegeneration are the entorhinal cortex and the hippocampus. Diagnosing Alzheimer’s disease is done by medicinal and neurological assessments and by using standardized tests/instruments. Currently only symptomatic treatments for Alzheimer’s disease are available; acetylcholine esterase inhibitors and memantine. Another treatment method is using monoclonal antibodies against Aβ to decrease the Aβ load in the brain. To assess the effectiveness of these drugs assessment methods based on cognitive and functional tests can be used.  Aim: This study aimed to analyse the efficacy and safety of anti-Aβ antibodies as a treatment for Alzheimer’s disease, which was done by analysing cognitive ability, biomarkers and adverse events.  Method: This literature study was based on 5 clinical randomized controlled trials which were obtained from the PubMed database. Keywords that were used in the searches were “aducanumab”, “lecanemab”, “donanemab”, “crenezumab” and “bapineuzumab”.  Results: High-dose aducanumab in the study EMERGE and lecanemab showed statistically significant differences on all endpoints, and analysis of biomarkers showed a decrease in amyloid load in the brain. Donanemab showed statistically significant differences on the primary endpoint and analysis of biomarkers but results on secondary endpoints were not statistically significant. Crenezumab only showed statistically significant change on the primary endpoint in CREAD2. Bapineuzumab did not show statistically significant differences on any endpoint or on changes in levels of biomarkers. Statistically significant results on primary and secondary endpoints indicated decreased cognitive impairment among the patients. ARIA was a common adverse event in all drugs, with exception of crenezumab, but the occurrence of ARIA was in most cases mild to moderate. Other common adverse events were infusion-related reactions, headaches and falls.  Conclusion: With consideration of the results of this paper a conclusion can be drawn that aducanumab, lecanemab and donanemab have been shown to be effective on primary endpoints and analysis of biomarkers. The drugs that seem the most promising are aducanumab and lecanemab, mainly because they showed efficacy on both primary and secondary endpoints, and biomarkers and because of the FDA’s recent approval of both drugs in the US. The occurrence of ARIA is something that affects the safety of these drugs and because of this more studies are needed to further assess their safety.

Introduction: Alzheimer's disease is a neurodegenerative disease that initially manifests itself primarily as impaired short-term memory and impaired language ability. The course of the disease is mainly due to an atrophy in the brain that can be attributed to the protein amyloid B and tau. Monoclonal antibodies that target Alzheimer's disease often have a high rate of cerebral edema, where proteinaceous fluid leaks into the extracellular space of the brain and creates edema. Some of the most common symptoms for amyloid-related imaging abnormalities (ARIA-E) are headache, dizziness, and blurred vision. In a few cases, patients with ARIA-E need to be hospitalized for observation, but most show a decline in ARIA-E within one to two months. Objective: To investigate the frequency of ARIA-E in clinical studies of monoclonal antibodies to patients with Alzhiemer's disease and to investigate the role of the ApoE4 allele in the development of ARIA-E. Method: Literature review of five RCT studies based on four different monoclonal antibodies. PubMed was used to search for the RCT-studies. Results: ARIA-E varies between different types of antibodies. ARIA-E usually occurs early in treatment when the degree of amyloid b is highest in the brain. Most cases are asymptomatic and treatment resumes within 1-2 months. Conclusion: Aria-E frequency correlates strongly with dose strength as well as APOE4 -status and most of the incidences are asymptomatic. With the right titration and individually selected drugs as well as individual dosages a safe care can be established for patients with Alzheimer's disease. If treatment is initiated at an early stage, the risk of side effects is reduced and more neurons can be saved from atrophy. The combination of several different types of medicine will further reduce the risk of ARIA-E.