Adverse Effects of Monoclonal Antibody Medications: ARIA Risks and Genotyping

The most concerning adverse effects of the monoclonal antibody drug DINANAMAP are amyloid-related imaging abnormalities (ARIA), which include MRI changes, microbleeds, and occasionally macrohemergies. ARIA-E, manifesting as DIMA or FUSIONs, occurred in 24% of patients treated compared to 2% in placebo, while ARIA-H, presenting as hemorrhage, occurred in 31% compared to 14% in placebo. The risk of ARIA is strongly related to the apolipoprotein E genotype, with apo-E4 homozygous individuals having the highest risk. In clinical practice, genotyping should be done prior to treatment for informed risk assessment. Although ARIA can be severe, about 75% of cases show no symptoms and resolve with treatment adjustment. However, in rare instances, ARIA can lead to serious complications, including stroke-like episodes, seizures, malignant hypertension, hospitalization, and even death.