Review of anti-amyloid-beta (Aβ) monoclonal antibodies for the treatment of Alzheimer's disease

Abstract

Introduction: Alzheimer's disease (AD) remains a major public health challenge, with growing prevalence and limited treatment options that modify disease progression. Recent advances have led to the development and approval of Anti-amyloid-β (Aβ) monoclonal antibodies, which represent a paradigm shift from symptomatic management to targeted disease modification.

Areas ccovered: Agents such as lecanemab and donanemab selectively bind aggregated forms of Aβ and have demonstrated modest but statistically significant slowing of cognitive and functional decline in early AD. However, these therapies are associated with amyloid-related imaging abnormalities (ARIA), particularly in individuals carrying the APOE ε4 allele, necessitating close monitoring and individualized risk assessment. Implementation challenges, including high treatment burden, cost, and real-world applicability, have limited broad clinical adoption. This review examines the mechanistic differences, clinical trial outcomes, and safety considerations of Aβ monoclonal antibodies, while also highlighting emerging therapies and the need for inclusive, precision-guided approaches.

Expert opinion: As research continues to evolve, balancing clinical benefits with safety and accessibility will be critical in defining the role of anti-amyloid-β therapies within the broader landscape of AD care.

Keywords: Alzheimer’s disease; amyloid-beta; amyloid-related imaging abnormalities (ARIA); biomarkers; disease-modifying therapy; donanemab; lecanemab.