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CC BY 4.0 · Arq Neuropsiquiatr 2025; 83(05): s00451808082
DOI: 10.1055/s-0045-1808082
Point of View

Monoclonal antibodies against beta-amyloid protein (lecanemab and donanemab) should not be used in the treatment of Alzheimer's disease

Ricardo Nitrini 
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brazil.
,
Adalberto Studart-Neto 
1   Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, Grupo de Neurologia Cognitiva e do Comportamento, São Paulo SP, Brazil.
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Abstract

Two antiamyloid monoclonal antibodies (mAbs), lecanemab and donanemab, were recently launched for treatment of Alzheimer's disease (AD). These mAbs remove amyloid protein from the brain and cause statistically significant improvement in cognitive/functional tests, meaning a change in evolution of AD. This is important to reinforce the amyloid cascade hypothesis and to further concentrate studies on the pathways from the deposition of the beta-amyloid protein to synaptic loss and neuronal death. However, it is necessary to evaluate whether the results are clinically important. Analysis of the clinical trials showed that the statistically significant differences over placebo did not reach the minimum clinically important difference that would be meaningful for patients, caregivers and clinicians. Besides, the incidence of adverse events is high and potentially severe. Although there are reasons to celebrate this first step towards disease-modifying therapies for AD, lecanemab and donanemab should not be used to treat AD in clinical pratice.

Keywords

Alzheimer Disease - Therapeutics - Antibodies, Monoclonal - Amyloid Cascade - Lecanemab - Donanemab - Minimum Clinically Important Difference

Authors' Contributions

RN: study design, data collection, analysis and/or interpretation of data, writing – original draft, and writing – review & editing; and ASN: data collection, analysis and/or interpretation of data, writing – original draft, 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-0045-1807718 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.




Publikationsverlauf

Eingereicht: 13. Februar 2025

Angenommen: 27. Februar 2025

Artikel online veröffentlicht:
09. Mai 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
Ricardo Nitrini, Adalberto Studart-Neto. Monoclonal antibodies against beta-amyloid protein (lecanemab and donanemab) should not be used in the treatment of Alzheimer's disease. Arq Neuropsiquiatr 2025; 83: s00451808082.
DOI: 10.1055/s-0045-1808082