The disclosure of APOE (apolipoprotein E) genotype in Alzheimer's disease clinical trials is under increased scrutiny following reports of safety risks associated with recently approved treatments like lecanemab and donanemab. These treatments have been linked to Amyloid Related Imaging Abnormalities (ARIA), including swelling and bleeding in the brain, particularly in individuals carrying the e4 variant of the APOE gene.
Historical Reluctance and Evolving Practices
Historically, the field has been hesitant to disclose APOE results due to concerns about the impact on clinical outcomes and potential discrimination. While the APOE e4 genotype is a known risk factor for developing Alzheimer's disease, its influence on disease progression and treatment outcomes was previously unclear. Furthermore, existing legal protections against genetic discrimination are imperfect, potentially affecting long-term care insurance and other areas.
The Impact of New Alzheimer's Treatments
The approval of lecanemab and donanemab has changed the landscape. APOE genotype now has a demonstrated impact on the risks associated with these treatments, necessitating a reevaluation of disclosure practices. UCI MIND investigators have provided guidance on this evolving issue, emphasizing the importance of informed consent and patient safety. In ongoing clinical trials, such as the AHEAD Study of lecanemab at UCI MIND, participants are given the opportunity to learn their APOE results before enrolling.
Balancing Information and Safety
More broadly, the disclosure of research results to participants requires careful consideration. Factors such as the participant's understanding of the results and the potential impact on their well-being must be taken into account. Investigators have a responsibility to provide clear and comprehensive information about the meaning and implications of research findings, rather than simply providing raw data. As stated in guidance developed for nationally funded Alzheimer's Disease Research Centers, a certain level of understanding of the meaning of the returned result is essential before even considering returning it to participants.
The desire to return as much information to participants as possible must be balanced with ensuring their safety. What can and cannot be shared changes over time, with new knowledge and research progress. This progress is not possible without the amazing people who participate in our studies. Our goal, after all, is to find solutions that work for them and all others who may face these diseases.
