Amyloid immunotherapy for Alzheimer's disease: the case for cautious adoption

The licensing of lecanemab and donanemab, disease-modifying immunotherapies for Alzheimer's disease (AD) targeting β-amyloid pathology, has been met with difference in opinion about efficacy, adverse effects, and cost-effectiveness. Here we summarize the current situation and make the case for cautious adoption of these treatments into clinical practice. This opinion is predicated on four main observations: 1) these treatments impact the core pathologies of AD and result in meaningful benefits; 2) while adverse effects can be serious, these are proving manageable in clinical practice; 3) upscaling services to deliver these agents is likely to provide wider benefits for diagnosing and treating dementia and facilitating the adoption of future treatments from the dementia drug pipeline; and 4) factoring in both the wider societal cost of care and potential for continued accrual of long term benefits will be likely to bring these treatments within acceptable cost-effectiveness thresholds.