Anti-amyloid immunotherapies for Alzheimer's disease: Administration, side effects, and overall framework

Recently, the Food and Drug Administration (FDA) approved the use of aducanumab (Aduhelm), lecanemab (Leqembi), and donanemab (Kisunla) in patients with mild cognitive impairment (MCI) and early-stage dementia secondary to Alzheimer's disease (AD). These medications-classified as anti-amyloid immunotherapies-reduce the burden of amyloid in the brain, as well as clinical decline as evidenced by cognitive assessments. Amyloid Related Imaging Abnormalities (ARIA), including ARIA-E (i.e., vasogenic edema) and ARIA-H (i.e., cerebral microhemorrhages), have been identified as important side effects. Given the novelty of these medications, limited educational resources are available to front line medical staff, primarily nurses, who are involved with patient education, administration of medications, and monitoring for side effects. The aim of this manuscript is to discuss the mechanism of action, indications, administration, and side effects associated with anti-amyloid immunotherapies and to provide medical staff with an assessment and educational framework to use in their practice.