Anti-Amyloid Monoclonal Antibodies and Amyloid-Related Imaging Abnormalities in Early Alzheimer Disease
DOI:
https://doi.org/10.5281/zenodo.22310607Keywords:
Alzheimer disease, Lecanemab, Donanemab, Aducanumab, Amyloid-related imaging abnormalitiesAbstract
Background: Lecanemab, donanemab and aducanumab clear cerebral amyloid-beta and modestly slow cognitive decline in early
symptomatic Alzheimer disease, but each carries a class-defining safety concern: amyloid-related imaging abnormalities (ARIA).
Objective: To review pivotal trial efficacy, ARIA incidence and mechanism, MRI monitoring, and management of anti-amyloid
monoclonal antibody therapy.Methods: Narrative review of pivotal randomized trials, imaging-society guidance, pharmacovigilance data, and case reports. Findings: Lecanemab reduced clinical decline by roughly 27% over placebo, with ARIA-E in 12.6% of treated patients; donanemab slowed decline by about 35%, with ARIA-E near 24%. Aducanumab trials gave discordant results. ARIA risk rises
several-fold in APOE4 homozygotes, and rare fatal hemorrhages have followed anticoagulation or thrombolysis.
Conclusions: Anti-amyloid antibodies offer modest, genuine benefit, but safe use depends on genotype-informed eligibility
screening and structured serial MRI monitoring.
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