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TAU: ONE OF TWO HALLMARK BIOMARKERS OF ALZHEIMER’S DISEASE (AD)1

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Along with clinical assessment, biomarker diagnostics can provide objective evidence when evaluating patients with cognitive impairment for AD or other causes.1

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Once symptoms are present and after a clinical assessment, tau biomarker testing can confirm the presence of 1 of 2 required components of the neuropathological diagnosis of AD and support a timely diagnosis.1-3

Many experts believe the neuropathology of AD has been shown to be closely associated with presence of both amyloid plaques and NFTs.4,5

HYPOTHETICAL MODEL OF THE SEQUENCES OF KEY BIOMARKER CHANGES IN AD5

Chart graphic

Hypothetical model of dynamic biomarkers of the AD pathological cascade, beginning with the abnormal accumulation of amyloid and the subsequent accumulation of tau, which leads to mild cognitive impairment (MCI) and eventually dementia.

Modified from Jack CR, Knopman DS, Jagust WJ, et al. Tracking pathophysiological processes in Alzheimer’s disease: an updated hypothetical model of dynamic biomarkers. Lancet Neurol. 2013;12(2):207-216.

Aβ=amyloid beta; MCI=mild cognitive impairment; NFT=neurofibrillary tangle.

A NEGATIVE TAUVID PET SCAN6

Two negative brain scans––a black and white scan and a colorful scan

Coronal, sagittal, and transverse flortaucipir PET images showing lack of density and distribution of aggregated tau neurofibrillary tangles, which is inconsistent with AD.

B: Off target binding in the choroid plexus or brainstem nuclei.
Row 1: Example of a patient with no increased neocortical activity (activity is similar in intensity to cerebellar reference region).
Row 2: Example of a patient with increased activity isolated to MTL.
Row 3: Example of a patient with increased neocortical activity isolated to frontal lobe.
Row 4: Example of a patient with small isolated foci of non-contiguous and variable uptake in the PLT (solid arrows); increased activity in the ALT (dashed arrows). This pattern may also be seen in the occipital or parietal region.

LOW TAUVID UPTAKE IN NEOCORTICAL GRAY MATTER6

  • A negative scan shows no increased neocortical activity or shows increased neocortical activity isolated to the mesial temporal, anterolateral temporal, and/or frontal regions

THE VALUE OF A NEGATIVE TAUVID PET SCAN

Know

  • Aggregated tau NFTs may be present at levels that qualify for the neuropathological diagnosis of AD in patients with a negative TAUVID scan6
  • Help avoid implications of misdiagnosis

Act

  • Consider additional evaluation to confirm the absence of AD pathology in these patients with a negative scan6

A POSITIVE TAUVID PET SCAN6

Two positive brain scans––a black and white scan and a colorful scan

Coronal, sagittal, and transverse flortaucipir PET images showing density and distribution of aggregated tau neurofibrillary tangles with patterns of flortaucipir retention consistent with AD.

A: Off target binding in the striatum.
Row 1: Example of a patient with increased uptake in PLT.
Row 2: Example of a patient with increased uptake in PLT and occipital regions.
Rows 3 and 4: Example of a patient with increased neocortical activity in PLT, occipital lobe (solid arrows) and
precuneus (dashed arrows) (row 3: level of temporal lobes, row 4: level of parietal/precuneus).
Row 5: Example of a patient with increased neocortical activity in medial prefrontal/cingulate, lateral prefrontal,
PLT, parietal, occipital and precuneus regions.

THE VALUE OF KNOWING TAU STATUS6

High TAUVID uptake in neocortical gray matter6

  • A positive scan shows increased neocortical activity in the PLT, occipital, or parietal/precuneus region(s), with or without frontal activity

THE VALUE OF A POSITIVE PET SCAN

Know

  • Supports presence of widely distributed tau neuropathology (B3 tau pathology*), which is 1 of the 2 pathologies associated with AD6,8

Act

  • In conjunction with clinical assessment, scan results may help you decide on appropriate next steps for diagnosis and management1

*A B3 tau pathology score refers to NFTs limited to transentorhinal brain region + NFTs limited to limbic brain regions + NFTs distributed throughout the neocortex.6

MCI=mild cognitive impairment; NFT=neurofibrillary tangle; PET=positron emission tomography; PLT=posterolateral temporal.

STUDY DESIGN

The performance of TAUVID imaging to estimate the density and distribution of aggregated tau NFTs was evaluated in 2 clinical studies6:

Study 1 (NCT02516046)

  • Assessed sensitivity and specificity of TAUVID imaging in patients who underwent autopsy6
  • Included 156 terminally ill patients who agreed to undergo TAUVID imaging and to participate in a postmortem brain donation program
    • 64 of the 156 patients underwent autopsy within 9 months of a TAUVID scan6,8
    • Reader interpretation based on scoring of the TAUVID scan was compared to tau pathology evaluating the density and distribution of NFTs in the postmortem brain6
    • Of the 64 patients, the mean age was 83 years (range 55 to 100); 34 were female; 49 had dementia, 1 had MCI, and 14 had no cognitive impairment on clinical evaluation around the time of TAUVID imaging6

Study 2 (NCT03901092)6

  • Assessed inter-reader reproducibility of TAUVID imaging in patients with and without autopsy
  • Included scans from 241 patients, including 64 patients with postmortem pathology confirmation from Study 1, 18 additional terminally ill patients, and 159 patients with cognitive impairment being evaluated for AD (the indicated population)
    • Inter-reader agreement for 5 new TAUVID readers was evaluated using Fleiss’ kappa statistic

Studies 1 and 2 included6

  • Two different groups of 5 independent readers who were blinded to clinical information
  • Binary (positive/negative) visual read methodology

AD has been defined by two neuropathological hallmarks, including amyloid plaques that are composed of aggregated forms of amyloid beta and neurofibrillary tangles that form within neurons and are composed of abnormally phosphorylated tau (or hyperphosphorylated tau).2,7

SEE HOW TAUVID MAY HELP IN THE DIAGNOSIS OF AD

DISCOVER HERE Right

TAUVID IS ACCURATE AND REPRODUCIBLE

EXPLORE EFFICACY Right

References:

  1. Porsteinsson AP, Isaacson RS, Knox S, et al. Diagnosis of early Alzheimer’s disease: clinical practice in 2021. J Prev Alzheimers Dis. 2021;8:371-386.
  2. Aisen PS, Cummings J, Jack CR Jr, et al. On the path to 2025: understanding the Alzheimer’s disease continuum. Alzheimers Res Ther. 2017;9(1):1-10.
  3. Sabbagh MN, Lue LF, Fayard D, et al. Increasing precision of clinical diagnosis of Alzheimer’s disease using a combined algorithm incorporating clinical and novel biomarker data. Neurol Ther. 2017;6(suppl 1):S83-S95.
  4. Alzheimer’s Association. 2020 Alzheimer’s disease facts and figures. Alzheimers Dement. 2020;16(3):1-93.
  5. Jack CR Jr, Knopman DS, Jagust WJ, et al. Tracking pathophysiological processes in Alzheimer’s disease: an updated hypothetical model of Dynamic biomarkers. Lancet Neurol. 2013;12(2):207-216.
  6. TAUVID (flortaucipir F 18 injection) Prescribing Information. Lilly USA, LLC.
  7. McDade E, Bednar M, Brashear HR, et al. The pathway to secondary prevention of Alzheimer’s disease. Alzheimers Dement (N Y). 2020;6(1):1-9.
  8. Fleisher AS, Pontecorvo MJ, Devous MD Sr, et al. Positron emission tomography imaging with [18F] flortaucipir and postmortem assessment of Alzheimer disease neuropathologic changes. JAMA Neurol. 2020;77(7):829-839.

Important Safety Information

Risk of Misdiagnosis in Patients Evaluated for Alzheimer’s disease (AD)

TAUVID does not target β-amyloid, one of two required components of the neuropathological diagnosis of AD. TAUVID performance for detecting tau pathology was assessed in terminally ill patients, the majority of whom had AD dementia with B3 level neurofibrillary tangle (NFT) pathology. TAUVID performance for detecting tau pathology may be lower in patients in earlier stages of the pathological spectrum.

Negative TAUVID Scan

NFTs may be present at levels that qualify for the neuropathological diagnosis of AD (B2 tau pathology in the presence of at least moderate levels of cortical amyloid pathology) in patients with a negative TAUVID scan. Consider additional evaluation to confirm the absence of AD pathology in patients with a negative TAUVID scan.

False Positive TAUVID Scan

Small foci of noncontiguous tracer uptake may lead to a false positive TAUVID scan. Only uptake of tracer in the neocortex should contribute to the interpretation of a positive TAUVID scan.

Risk of Chronic Traumatic Encephalopathy Misdiagnosis

The safety and effectiveness of TAUVID have not been established for patients being evaluated for CTE. Preliminary non-clinical and clinical investigations suggest differences in tau conformation and distribution may limit flortaucipir F 18 binding. Therefore, TAUVID is not indicated for detection of CTE.

Radiation Risk

Diagnostic radiopharmaceuticals, including TAUVID, expose patients to radiation. Radiation exposure is associated with a dose-dependent increased risk of cancer. Ensure safe handling and preparation procedures to protect patients and health care workers from unintentional radiation exposure.

ADVERSE REACTIONS

The most common adverse reactions reported in clinical trials were headache (1.4%), injection site pain (1.2%), and increased blood pressure (0.8%).

USE IN SPECIAL POPULATIONS

Pregnancy

All radiopharmaceuticals, including TAUVID, have the potential to cause fetal harm depending on the fetal stage of development and the magnitude of radiation dose. Advise a pregnant woman of the potential risks of fetal exposure to radiation doses with administration of TAUVID.

Lactation

Advise a lactating woman to avoid breastfeeding for 4 hours after TAUVID administration in order to minimize radiation exposure to a breastfed infant.

FT HCP ISI 14SEP2022

Please see Full Prescribing Information for TAUVID .

Indication(s)

TAUVID is indicated for use with positron emission tomography (PET) imaging of the brain to estimate the density and distribution of aggregated tau neurofibrillary tangles (NFTs) in adult patients with cognitive impairment who are being evaluated for Alzheimer’s disease (AD).

Limitations of Use

TAUVID is not indicated for use in the evaluation of patients for chronic traumatic encephalopathy (CTE).

  • TAUVID for intravenous (IV) use is supplied in multidose vial containing 300-3700 Mbq/mL flortaucipir F 18
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