This narrative review examines the safety and efficacy of donanemab and lecanemab and discusses the implications for patient access and care. Clinical trials published between June 2021 to July 2024, discussing phase II and III clinical trial data for donanemab and lecanemab were reviewed. In phase II and phase III trials, donanemab and lecanemab showed significant reductions in amyloid plaque compared to placebo. Lecanemab reduced brain Positron Emission Tomography (PET) amyloid levels and slowed clinical decline, with phase III trials showing a 49% reduction in EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) decline and a 56% reduction in quality of life in Alzheimer's Disease decline (self-rated) compared to placebo. The most common adverse effects associated with donanemab and lecanemab were Amyloid-Related Imaging Abnormalities (edema and hemorrhage) and injection site reactions. Lecanemab and donanemab display moderate benefit but increase the risk of potentially serious adverse effects. Additionally, challenges related to high cost and access issues necessitate coordinated efforts from stakeholders, including healthcare providers, insurers, policymakers, and patient advocacy groups, to ensure equitable access and affordability for all patients. As the Alzheimer’s Disease treatment landscape evolves, addressing challenges related to access and affordability will be critical in shaping policies that support patient access to these innovative treatments.
Goswami et al. (2026) studied this question.