Updated Italian intersocietal recommendations for the appropriate use of anti-amyloid monoclonal antibodies in Alzheimer's disease

With the European authorisation of lecanemab and donanemab, Italy is entering the era of disease-modifying therapy for early symptomatic Alzheimer's disease. The Italian Expert Panel on Alzheimer (EPA), which convened 21 scientific societies and patient associations and published a first set of intersocietal recommendations in 2025, was reconvened in Rome on 24 January 2026 (EPA2) to address the operational gaps that had emerged during the implementation of that document. A modified Delphi process was adopted to formalise consensus on the most controversial points raised during the meeting. Thirty-six declarative statements covering five domains, namely the tiered organisation of the Centres for Cognitive Disorders and Dementia (CDCD), clinical staging and treatment monitoring, eligibility considerations in mild cognitive impairment and atypical phenotypes, composition of the multidisciplinary team, and magnetic resonance imaging thresholds, ARIA monitoring and biomarker pathway, were submitted to a multidisciplinary panel of experts. Strong agreement was reached on the large majority of statements, providing quantitative endorsement for a competence-based reorganisation of the CDCD network, the harmonised use of the Clinical Dementia Rating, an explicit composition of the multidisciplinary team, trial-aligned magnetic resonance imaging eligibility criteria with a move towards risk-adapted ARIA monitoring, and a stepwise biomarker pathway integrating plasma assays, cerebrospinal fluid analysis on automated platforms and amyloid positron emission tomography. The document provides Italian regional and national health systems, prescribing centres and reimbursing authorities with a quantitative blueprint for the appropriate, equitable and sustainable use of anti-amyloid monoclonal antibodies in clinical practice.

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Journal
The Journal of Prevention of Alzheimer s Disease
Published
2026-10-15
DOI
https://doi.org/10.1016/j.tjpad.2026.100685
Primary Topic
Alzheimer's disease research and treatments
Type
article
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article

Updated Italian intersocietal recommendations for the appropriate use of anti-amyloid monoclonal antibodies in Alzheimer's disease

Leonardo Pantoni, Walter Marrocco, Elena Marcello, Luca Roccatagliata et al.
The Journal of Prevention of Alzheimer s Disease
Alzheimer's disease research and treatments
article

Updated Italian intersocietal recommendations for the appropriate use of anti-amyloid monoclonal antibodies in Alzheimer's disease

Leonardo Pantoni, Walter Marrocco, Elena Marcello, Luca Roccatagliata, Sandro Sorbi, Mirco Cosottini, Giuseppe Bruno, Enrico Mossello, Sonia Francesca Calloni, Patrizia Mecocci, Raffaele Lodi, Lucilla Parnetti, Stefano Francesco Cappa, Federica Agosta, Alessandra Splendiani, Giuseppe Bellelli, Alba Rosa Alfano, Patrizia Spadin, Diego Cecchin, Ovidio Brignoli, Laura Bonanni, Camillo Marra, Alberto Benussi, Mattia Altini, Lorenzo Palleschi, Pasquale J Palumbo, Marcello Ciaccio, Andrea Ungar, Luisa Agnello, Giuseppe Zappalà, Fabio Gotta, Marco Bozzali, Stefania Basilico, Silvia Daniela Morbelli, Alessandro Padovani, Lorenzo Gaetani, Gabriella Bottini, Antonio Antico, Annachiara Cagnin, Filippo Caraci, Nicoletta Gandolfo, Andrea Falini, Sirio Cocozza, Diego De Leo, Giancarlo Logroscino, Alessandro Tessitore
article en

Abstract

With the European authorisation of lecanemab and donanemab, Italy is entering the era of disease-modifying therapy for early symptomatic Alzheimer's disease. The Italian Expert Panel on Alzheimer (EPA), which convened 21 scientific societies and patient associations and published a first set of intersocietal recommendations in 2025, was reconvened in Rome on 24 January 2026 (EPA2) to address the operational gaps that had emerged during the implementation of that document. A modified Delphi process was adopted to formalise consensus on the most controversial points raised during the meeting. Thirty-six declarative statements covering five domains, namely the tiered organisation of the Centres for Cognitive Disorders and Dementia (CDCD), clinical staging and treatment monitoring, eligibility considerations in mild cognitive impairment and atypical phenotypes, composition of the multidisciplinary team, and magnetic resonance imaging thresholds, ARIA monitoring and biomarker pathway, were submitted to a multidisciplinary panel of experts. Strong agreement was reached on the large majority of statements, providing quantitative endorsement for a competence-based reorganisation of the CDCD network, the harmonised use of the Clinical Dementia Rating, an explicit composition of the multidisciplinary team, trial-aligned magnetic resonance imaging eligibility criteria with a move towards risk-adapted ARIA monitoring, and a stepwise biomarker pathway integrating plasma assays, cerebrospinal fluid analysis on automated platforms and amyloid positron emission tomography. The document provides Italian regional and national health systems, prescribing centres and reimbursing authorities with a quantitative blueprint for the appropriate, equitable and sustainable use of anti-amyloid monoclonal antibodies in clinical practice.

The Journal of Prevention of Alzheimer s DiseaseVol. 13(10)
University of Primorska (SI), University of Padua (IT), Vita-Salute San Raffaele University (IT), University of Milan (IT), University of Campania "Luigi Vanvitelli" (IT), University of Perugia (IT), Azienda Ospedaliera San Giovanni Addolorata (IT), Istituto Universitario di Studi Superiori di Pavia (IT), Agostino Gemelli University Polyclinic (IT), Karolinska Institutet (SE), University of Catania (IT), University of Chieti-Pescara (IT), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Luigi Sacco Hospital (IT), Azienda Unita' Sanitaria Locale Di Modena (IT), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), San Salvatore Hospital (IT), Ospedale Garibaldi (IT), Department of Medical Sciences (RU), Azienda Ospedaliero-Universitaria Careggi (IT), Don Carlo Gnocchi Foundation (IT), Federico II University Hospital (IT), Associazione Italiana per l'Agricoltura Biologica (IT), Istituto delle Scienze Neurologiche di Bologna (IT), IRCCS Ospedale San Raffaele (IT), IRCCS Istituto Auxologico Italiano (IT), Ca' Foncello Hospital (IT), Ospedale Policlinico San Martino (IT), Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone" di Palermo (IT), University of the Sacred Heart (JP), Ospedale di Prato Santo Stefano (IT), Azienda Sanitaria Universitaria Integrata di Trieste (IT), Azienda Ospedaliera Universitaria Pisana (IT), Hospital of Prato (IT), Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT), University of Florence (IT), University of Bari Aldo Moro (IT), University of Milano-Bicocca (IT), University of Brescia (IT), University of Genoa (IT), Sapienza University of Rome (IT), University of Palermo (IT)
Good health and well-being
Openalex Percentile: Top 13%
Alzheimer's disease research and treatments
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