Background: Alzheimerââ?¬â?¢s disease (AD) is a globally prevalent neurodegenerative condition, clinically characterized\nby progressive memory loss and gradual impairment of cognitive functions. Bapineuzumab is a fully humanized\nmonoclonal antibody that binds to neurotoxic amyloid proteins in the brain, enhancing their clearance. We\nperformed this systematic review and meta-analysis to evaluate the safety and efficacy of bapineuzumab in patients\nwith mild to moderate Alzheimerââ?¬â?¢s disease.\nMethods: We performed a web-based literature search of PubMed, Ovid, EBSCO, Scopus, Embase, Cochrane\nCENTRAL, and web of science using the relevant keywords. Data were extracted from eligible records and pooled\nas mean difference (MD) or risk ratio (RR) values with their 95% confidence interval (CI), using Review Manager\nsoftware (version 5.3 for windows). Heterogeneity was measured by Chi-square and I-square tests.\nResult: The pooled effect estimate from six randomized clinical trials (n = 2380) showed that bapineuzumab\nsignificantly reduced the cerebrospinal fluid concentration of phosphorylated tau proteins (Standardized MD = âË?â??5.53,\n95% CI [âË?â??8.29, âË?â??2.76]). However, the bapineuzumab group was not superior to the placebo group in terms of change\nfrom baseline in Alzheimerââ?¬â?¢s disease assessment scale (ADAS)-Cog11 (MD = 0.14, 95% CI [âË?â??0.72, 0.99]), disability\nassessment for dementia (DAD) scale (MD = 1.35, 95% CI [âË?â??1.74, 4.43]), and mini-mental state examination (MMSE)\nscores (MD = 0.08, 95% CI [âË?â??0.31, 0.47]). Regarding safety, bapineuzumab increased the risk of serious treatmentemergent\nadverse events (RR = 1.18, 95% CI [1.02, 1.37]) and cerebral vasogenic edema (RR = 40.88, 95% CI [11.94, 135.\n95]). All bapineuzumab doses (0.15, 0.5, 1, and 2 mg/kg) were similar to placebo in terms of change from baseline in\nADAS-cog11, DAD, and MMSE scores, except for the 0.15 mg/kg dose, which caused a significant worsening on the\nADAS-cog11 scale (MD = 5.6, 95% CI [0.22, 10.98]).\nConclusions: Considering the lack of clinical efficacy, combined with the significant association with serious adverse\nevents, bapineuzumab should not be used to treat patients with mild to moderate AD. Future studies should\ninvestigate the effect of combining bapineuzumab with other therapeutic strategies and reevaluate the efficacy of\ntargeting amyloid Ã?² proteins in AD therapy.
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