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CC BY 4.0 · Arq Neuropsiquiatr 2025; 83(05): s00451807718
DOI: 10.1055/s-0045-1807718
Point of View

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

Jonathan M. Schott 
1   University College London, Queen Square Institute of Neurology, Dementia Research Centre, London, United Kingdom.
,
Charles R. Marshall 
2   Queen Mary University of London, Wolfson Institute of Population Health, Centre for Preventive Neurology, London, United Kingdom.
› Author Affiliations Funding JMS is supported by the National Institute for Health and Care Research University College London Hospitals (NIHR UCL/H) Biomedical Research Centre and is an NIHR Senior Investigator.
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Abstract

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.

Keywords

Alzheimer Disease - Immunotherapy - Amyloid - Cost-Benefit Analysis

Authors' Contributions

JMS: conceptualization and writing – original draft; and CRM: conceptualization and writing – review & editing.


This article is part of a debate series on Amyloid, featuring different perspectives. Check out the other points of view: https://doi.org/10.1055/s-0045-1808082 and https://doi.org/10.1055/s-0045-1808083.


Editor-in-Chief: Hélio A. G. Teive.


Associate Editor: Carlos Henrique Ferreira Camargo.


Guest Editor: Paulo Caramelli.




Publication History

Received: 13 February 2025

Accepted: 27 February 2025

Article published online:
09 May 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Jonathan M. Schott, Charles R. Marshall. Amyloid immunotherapy for Alzheimer's disease: the case for cautious adoption. Arq Neuropsiquiatr 2025; 83: s00451807718.
DOI: 10.1055/s-0045-1807718