Antiamyloid Monoclonal Antibodies in Alzheimer’s Disease, Part 1: Patient Selection

The availability of monoclonal antibodies directed against amyloid beta, for use as disease-modifying therapies for Alzheimer's disease (AD), represented a major shift in the field of AD research and treatment. U.S. Food and Drug Administration approvals for the monoclonal antibody-based medications lecanemab and, more recently, donanemab provide clinicians with two antiamyloid therapy (AAT) options for targeting early symptomatic AD. The emergence of AAT has made careful biomarker-informed diagnosis of AD paramount, which was once reserved for highly specialized centers and research settings. Patient selection is complex, and although appropriate-use recommendations have been published, clinicians caring for patients with AD across the United States face uncertainty when trying to align clinical trial criteria, appropriate-use recommendations, and real-world patients in the clinic. Practical issues in patient selection as well as health care and systemic challenges in the implementation of AAT are considered in part 1 and part 2, respectively, of this two-part Treatment in Behavioral Neurology & Neuropsychiatry commentary on these therapies from the American Neuropsychiatric Association Dementia Special Interest Group.