Treatment flow of anti–amyloid therapy for patients with early Alzheimer disease

Abstract

Anti–amyloid therapies for Alzheimer disease (AD), lecanemab and donanemab, are now available in clinical practice. We described the flow of anti–amyloid therapy for patients with early AD in actual clinical practice. We examined 107 patients between January 2024 and January 2025 and completed testing to determine whether anti–amyloid therapy was feasible. Seventy–two of the 107 patients (67%) started anti–amyloid therapy, but 35 patients could not receive treatment due to amyloid–β pathology negative or many cerebral microbleeds etc. or it was not recommended due to the use of anti–platelet or anticoagulant therapies or concerns about side effects of amyloid related imaging abnormality (ARIA) due to apolipoprotein E (APOE) ε4 homozygotes. The incidence rates of ARIA, a side effect of anti–amyloid therapies, clearly differs depending on whether APOE ε4 is present, and management of ARIA is considered to be very important to reduce concerns about anti–amyloid therapies. We also touch on regional collaboration between hospitals where the anti–amyloid therapies begin (the facility which had many specialists) and the treatments will be continued (the facility which located near the patient's home), which is important for continuing treatment for patients.