BOSTON — When should amyloid-targeting therapies for the treatment of early symptomatic Alzheimer’s disease?
A new article from the VA Boston Healthcare System and Boston University Chobanian and Avedisian School of Medicine and colleges discussed some considerations.
Amyloid-targeting therapies (ATTs), including donanemab and lecanemab, are Food and Drug Administration-approved disease-modifying therapies for Alzheimer’s disease in the mild cognitive impairment or mild dementia stages.
The authors write in Frontiers in Neurology that early initiation is important for optimal outcomes. Their article summarizes practical strategies for implementing ATTs in clinical practice, focusing on leadership alignment and infrastructure development, as well as patient identification, diagnosis and monitoring protocols.
Key recommendations include:
- establishing appropriate patient tracking systems,
- infusion and imaging protocols and
- interprofessional collaboration.
“Approaches for systematic patient routing (e.g., hub-and-spoke models, fast-track mechanisms) and biomarker-integrated assessments are critical to facilitating timely diagnosis and treatment,” the article noted. “Education for patients, care partners, and clinicians is crucial for managing the risks associated with amyloid-related imaging abnormalities. Successful ATT implementation requires coordinated systems, timely diagnosis, and robust safety monitoring. These measures can enable frameworks for ATT administration to optimize outcomes for patients, care partners, and health systems.”
Background information in the article pointed out that donanemab and lecanemab have demonstrated slowing of cognitive and functional decline across trials, subgroups and outcome measures over 18 months, with early evidence for persistent benefit thereafter in open-label and blinded extension studies.
“As the first widely-utilized disease-modifying therapies for the treatment of AD, the real-world knowledge and infrastructure for identifying appropriate patients and optimizing drug delivery are being developed across practices that care for patients with AD,” the authors wrote, adding, “Because initiation of treatment in the earlier symptomatic stages of AD is an important factor in better outcomes, clinics and health systems need to facilitate early and accurate diagnosis and access to appropriate treatment options.”
The practical guidance to support the safe and effective implementation of ATTs in clinical practice is primarily intended for neurologists, geriatricians, psychiatrists and healthcare teams who care for patients with AD. “Although these specialists are currently central to ATT prescribing and safety monitoring, we also acknowledge that the specialist workforce is insufficient to meet demand and highlight that primary care clinicians participating in shared-care models are central, rather than peripheral, to feasible implementation,” according to the report.
- Budson AE, Ljubenkov PA, Ritter A, Leahy C, Ramanan VK, Brosch J, Burke A, Matthews BR. Considerations for using amyloid-targeting therapies for the treatment of early symptomatic Alzheimer’s disease. Front Neurol. 2026 Aug 10;17:1863897. doi: 10.3389/fneur.2026.1863897. PMID: 42643714; PMCID: PMC13504022.
