# Anti-amyloid antibody treatment | Symptoms, Causes, Tests and Treatment | OSANG > Anti-amyloid antibody treatment is a monoclonal antibody that targets and removes beta-amyloid accumulated in the brain, and representative examples include lecanemab an… - Official page: https://osns.co.kr/en/encyclopedia/anti-amyloid-antibody - Organization: OSANG Neurosurgery ## Page content Dementia/Cognition ## Anti-amyloid antibody treatment Anti-Amyloid Antibody Therapy Anti-amyloid antibody therapy is a monoclonal antibody treatment that targets and removes beta-amyloid, the causative agent of Alzheimer's disease, and is used to slow the progression of cognitive decline in early-stage Alzheimer's disease with confirmed amyloid positivity. ## At a glance Anti-amyloid antibody treatment is a monoclonal antibody that targets and removes beta-amyloid accumulated in the brain, and representative examples include lecanemab and donanemab. In the CLARITY-AD trial, lecanemab slowed the worsening of the Clinical Dementia Scale (CDR-SB) sum score (CDR-SB) by approximately 27% compared to placebo at 18 months. Donanemab also significantly slowed cognitive and functional deterioration in phase 3. Amyloid-related imaging abnormalities (ARIA) are a major side effect, requiring regular MRI monitoring during treatment. - 01Definition and Overview - 02Mechanism of Action - 03Indications - 04clinical evidence - 05side effects - 06Limitations and Considerations ## Definition and Overview Anti-amyloid antibody therapy is a monoclonal antibody treatment designed to target and remove beta-amyloid protein, the core pathology of Alzheimer's disease. Unlike existing treatments that relieve symptoms, it is a disease-modifying therapy that directly reduces the causative agent of the disease. In Alzheimer's disease, beta-amyloid aggregates in the brain, forming amyloid plaques and causing nerve damage. Anti-amyloid antibodies bind to this amyloid and promote immune-mediated clearance, ultimately lowering the amyloid burden in the brain. Representative drugs include lecanemab and donanemab and are administered by intravenous injection. ## Mechanism of Action Lecanemab binds first to soluble amyloid protofibrils in the aggregation stage, and donanemab binds to amyloid in deposited senile plaques. When the antibody binds to amyloid, its removal through microglia is promoted and the brain amyloid PET signal decreases. It is based on the hypothesis that amyloid clearance leads to delayed clinical progression, and in a phase 3 trial, delayed cognitive decline was observed along with amyloid reduction on PET. ## Indications The target is early-stage Alzheimer's disease, which ranges from mild cognitive impairment to mild dementia. Before treatment, brain amyloid positivity must be confirmed using amyloid PET or cerebrospinal fluid biomarkers, and amyloid-negative or moderately advanced dementia is not an indication. Appropriate use recommendations include baseline MRI, APOE genotyping, and review of bleeding risk. ## clinical evidence In the CLARITY-AD phase 3 trial of lecanemab, the deterioration of the Clinical Dementia Scale Total Score (CDR-SB) at 18 months was approximately 27% slower than placebo, and significant differences were also seen in cognitive and daily function auxiliary indicators. In the TRAILBLAZER-ALZ 2 trial of donanemab, cognitive and functional deterioration was significantly delayed compared to placebo in the Integrated Alzheimer's Disease Rating Scale (iADRS) and CDR-SB. The effect of both tests is to slow the progression and does not restore damaged cognitive function to normal. A decision must be made that considers the benefits of treatment, the risk of side effects, and the burden of regular injections and imaging tests. ## side effects The most noteworthy side effect is amyloid-related imaging abnormalities (ARIA). ARIA is divided into cerebral edema due to increased vascular permeability (ARIA-E) and microhemorrhage/superficial iron deposition (ARIA-H). It is mostly asymptomatic, but may be accompanied by headache, dizziness, confusion, and visual symptoms, and rarely has a severe course. Therefore, regular MRI monitoring is necessary during treatment. ARIA risk is high in APOE ε4 carriers, especially homozygotes. The risk of bleeding increases if you are taking anticoagulants, have multiple microbleeds, or have cerebral amyloid angiopathy. Infusion reactions related to injections may also occur. ## Limitations and Considerations This treatment is limited to early-stage patients and requires confirmation of amyloid biomarkers for diagnosis and repeated MRI surveillance during treatment. The effect is a mild delay in progress, and comes with the burden of cost, accessibility, and safety monitoring. Decisions based on appropriate target selection, risk assessment, and sufficient explanation are important. ## Frequently asked questions ### Q01What kind of drug is anti-amyloid antibody? It is a monoclonal antibody designed to directly target and remove beta-amyloid protein accumulated in the brain of Alzheimer's disease. Unlike existing drugs that only relieve symptoms, they aim to reduce the causative agent of the disease, and examples include lecanemab and donanemab. Administered intravenously. ### Q02Which patients are eligible for treatment? The target is early-stage Alzheimer's disease, which corresponds to mild cognitive impairment to mild dementia, and the presence of amyloid in the brain must be confirmed through an amyloid PET or cerebrospinal fluid test before treatment. It is not indicated for cases of moderately advanced dementia or amyloid-negative cases. ### Q03How effective is it? In the CLARITY-AD trial, lecanemab slowed the worsening of the Clinical Dementia Scale (CDR-SB) sum score (CDR-SB) by approximately 27% compared to placebo at 18 months. In the TRAILBLAZER-ALZ 2 trial of donanemab, cognitive and functional deterioration was also significantly delayed. It has the effect of slowing down the progression and does not return cognitive function to normal. ### Q04What is ARIA? Amyloid-related imaging abnormalities (ARIA) are the main side effects of this class of drugs and are divided into cerebral edema (ARIA-E) and microhemorrhage/superficial siderosis (ARIA-H). Most patients have no symptoms, but headaches, dizziness, and confusion may occur, so regular MRI monitoring is necessary during treatment. ### Q05Do some people need attention? If you have the apolipoprotein E ε4 (APOE ε4) gene, your risk of ARIA increases. If you are taking anticoagulants, have multiple microbleeds, or have cerebral amyloid angiopathy, the risk of bleeding is high and careful evaluation is necessary. Risk is assessed using genetic testing and baseline MRI before treatment. ### Q06Can it be used together with existing dementia medications? Because it has a different mode of action, it can be used in combination with cholinesterase inhibitors or memantine. Anti-amyloid antibodies reduce causative substances, and existing drugs play a role in alleviating cognitive symptoms. Whether to use the drug together is decided by a specialist considering the patient's stage and risk factors. ## Related articles - Dementia Overview - Alzheimer's disease - vascular dementia - Lewy body dementia This article provides general medical information and does not replace an individual diagnosis or treatment plan. Please seek a medical assessment if symptoms persist. ## Important notice This Markdown alternative helps search and AI tools understand the public page accurately. It provides general health information and does not replace an individual diagnosis or treatment.