Aducanumab and adenoviral COVID-19 vaccines: increased cerebral hemorrhage risk?

The U.S. Food and Drug Administration’s approval of aduca-numab – an anti-amyloid human immunoglobulin G1 (IgG1)monoclonal antibody for treating Alzheimer’s disease – hasignited a firestorm of debate [1]. Proponents of the FDAapproval suggest that aducanumab promises a disease-modifying therapy for AD. Opponents (including thePeripheral and Central Nervous System Drugs AdvisoryCommittee of FDA) are mainly concerned about uncertainclinical benefits and the risk of harm. Amyloid-related imagingabnormalities (ARIA) and its two presentation types of micro-hemorrhage and superficial siderosis (ARIA-H), and edema(ARIA-E) are the principal adverse reactions of aducanumabthat might be more pronounced and serious in real-worldscenarios [2,3]. Besides, due to the lack of post-marketingexperience, there is very scarce knowledge about interactionswith other drugs; so far, no contraindications have been regis-tered [3]. Thus, it is quintessential to foresee any significantinteractions with widely used drugs. Worsening of the sideeffect profile could further jeopardize the already questionedrisk/benefit profile of this treatment.