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Blog | Therapeutic plasma exchange with albumin in Alzheimer's disease

Alzheimer's is a pathology that affects millions of people and represents an enormous social and health burden, which is why the World Health Organization has declared the control of dementia as a global health priority.

The same international organization estimates that currently more than 55 million people worldwide suffer from dementia and forecasts that this figure will be around 80 million by 2030, with Alzheimer's disease being the cause of 60% to 70% of cases.

Alzheimer's is a neurodegenerative disease that causes a progressive deterioration of cognitive functions, such as memory, orientation or language, as well as a change in behavior and social skills. Alzheimer's disease is the most common cause of dementia for which there is still no treatment that can stop or alter its course.

The person with Alzheimer's slowly loses their autonomy so that in a certain period of time they reach a situation of complete dependence, thus affecting their closest environment, such as family or friends.

The AMBAR® procedure

In October 2020, the results of the AMBAR® clinical trial, an acronym for Alzheimer's Management By Albumin Replenishment, were published in the prestigious journal Alzheimer's & Dementia.

The trial, designed by Grifols in collaboration with the Ace Alzheimer Center Barcelona and the Alzheimer's Disease Research Center in Pittsburgh (USA), aimed to evaluate the efficacy and safety of therapeutic plasma exchange, also called plasmapheresis, for 14 months in patients with Alzheimer's disease. Mild and moderate Alzheimer's.

Therapeutic plasma exchange is an extracorporeal blood purification technique that has been used for several years in medicine and is mainly used in diseases related to the immune system.

It consists of extracting blood through one of the veins in our arms, then a pre-established amount of plasma is removed to return our blood again with a replacement solution, in this case, albumin. With this, the blood volume is not altered and large particles present in the blood are eliminated.

The AMBAR® study included 347 participants who were randomly divided into four groups: three groups received treatment with different doses of albumin and were compared with a fourth control group who received placebo treatment.

At the end of the study, people treated with albumin plasma exchange showed better scores compared to the placebo group in cognitive and functional assessments or abilities to perform tasks of daily living. Therefore, the authors of the AMBAR® study concluded that therapeutic plasma exchange with albumin replacement could delay cognitive and functional decline in patients with mild or moderate Alzheimer's disease.

AMBAR® an effective and safe avant-garde procedure

A total of 4,709 plasma exchanges were performed during the study, of which 90% were uneventful. Adverse effects related to the technique were controllable and mild, demonstrating that this procedure is feasible and safe to perform in the population studied.

Since May 2021 at the AMBAR® Center, promoted by Grifols and Ace Alzheimer Center Barcelona, a specialized team made up of neurologists, intensivists, neuropsychologists and nurses specialized in therapeutic plasma exchange have performed this technique in people with mild Alzheimer's disease and moderate following the guidelines of the AMBAR® study, individualizing the treatment to each particular case and with rigorous follow-up by the entire team, guaranteeing patient safety.

To date, more than a hundred patients have come to the AMBAR® Center looking for a therapeutic alternative for Alzheimer's disease. This has allowed us to deepen our knowledge of the technique and has provided us with information on the use of the treatment in the real world.

These data will be presented by Dr. Mercè Boada at the annual meeting of the American Society for Apheresis to be held in Philadelphia, United States, in May. In said oral communication, the results of the first 240 procedures performed at the AMBAR® Center will be disseminated, highlighting the safety and good tolerability of Therapeutic Plasma Exchange.

Bibliography. BoadaM, López OL, Olazarán J, et al. A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer’s disease: Primary results of the AMBAR Study. Alzheimer’s Dement. 2020;16:1412–1425. https://doi.org/10.1002/alz.12137

 

JUAN PABLO TARTARI

Neurologist at AMBAR® Center and Ace Alzheimer Center Barcelona

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