Several approved Alzheimer's disease (AD) treatments help manage its associated cognitive symptoms (e.g., donepezil and memantine) or non-cognitive symptoms. However, disease-modifying AD therapies have recently emerged. These treatments aim to slow disease progression by targeting the pathology associated with progressive neurodegeneration. Specifically, two amyloid-targeting therapies (ATTs) are currently approved and available for use in the United States: the monoclonal antibodies donanemab (Kisunla™) and lecanemab (Leqembi®). Both treatments can slow disease progression and cognitive and functional decline in patients with mild cognitive impairment/mild dementia due to AD, but they are associated with class-based safety concerns, notably amyloid-related imaging abnormalities (ARIA). Because advanced practice providers (APPs) such as physician assistants and advanced practice nurses are key to AD patient care, they should be familiar with the biological continuum of AD and with ATTs and understand how to monitor and manage patients receiving these treatments. Therefore, this review aims to educate APPs about these new therapies. Specifically, it summarizes the approved indications and dosing for donanemab and lecanemab, as well as key clinical evidence of efficacy and safety. It also outlines practical considerations around the monitoring and management of patients treated with ATTs, including recommendations about treatment duration, adverse reaction management, and patient counseling.
Kovacik et al. (Mon,) studied this question.