Bateman James R, Carlisle Tara C, Yang Yanghong, Lachner Christian, Stockbridge Melissa D, Flashman Laura A, Chemali Zeina, Alzbeidi Nasir, Pressman Peter S, Osibajo Anne-Marie, Bobrin Bradford D, Martinez-Menendez Carlos J, Teixeira Antonio L, Daffner Kirk R
Department of Neurology, Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, N.C. (Bateman, Flashman); Department of Neurology, Behavioral Neurology Section, University of Colorado School of Medicine, Aurora (Carlisle, Pressman); Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, and Department of Neurology, SUNY Downstate Medical Center, New York City (Yang); Departments of Neurology and Psychiatry and Psychology, Mayo Clinic, Jacksonville, Fla. (Lachner); Department of Neurology, Cerebrovascular Division, Johns Hopkins University School of Medicine, Baltimore (Stockbridge); Department of Neurology, Harvard Medical School, Brigham and Women's Hospital, Boston (Chemali); Sakina Mental Health Services, SEHA, Abu Dhabi, United Arab Emirates (Alzbeidi); Department of Psychiatry, Atlantic Health System-Overlook Medical Center, Summit, N.J., and Department of Neurology, Icahn School of Medicine at Mount Sinai, New York City (Osibajo); Lower Merion Counseling Services, Lower Merion, Pa. (Bobrin); Department of Neurology, University of Texas Health Rio Grande Valley, Harlingen (Martinez-Menendez); Department of Neurology, Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases, University of Texas Health Science Center at San Antonio, San Antonio (Teixeira); Department of Neurology, Division of Cognitive and Behavioral Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston (Daffner).
J Neuropsychiatry Clin Neurosci. 2025 May 5:appineuropsych20240191. doi: 10.1176/appi.neuropsych.20240191.
The availability of monoclonal antibodies directed against amyloid beta, for use as disease-modifying therapies for Alzheimer's disease (AD), represented a major shift in the field of AD research and treatment. U.S. Food and Drug Administration approvals for the monoclonal antibody-based medications lecanemab and, more recently, donanemab provide clinicians with two antiamyloid therapy (AAT) options for targeting early symptomatic AD. The emergence of AAT has made careful biomarker-informed diagnosis of AD paramount, which was once reserved for highly specialized centers and research settings. Patient selection is complex, and although appropriate-use recommendations have been published, clinicians caring for patients with AD across the United States face uncertainty when trying to align clinical trial criteria, appropriate-use recommendations, and real-world patients in the clinic. Practical issues in patient selection as well as health care and systemic challenges in the implementation of AAT are considered in part 1 and part 2, respectively, of this two-part Treatment in Behavioral Neurology & Neuropsychiatry commentary on these therapies from the American Neuropsychiatric Association Dementia Special Interest Group.
针对淀粉样β蛋白的单克隆抗体可作为阿尔茨海默病（AD）的疾病修饰疗法，这代表了AD研究和治疗领域的重大转变。美国食品药品监督管理局批准了基于单克隆抗体的药物lecanemab，以及最近批准的donanemab，为临床医生提供了两种针对早期症状性AD的抗淀粉样蛋白疗法（AAT）选择。AAT的出现使得基于生物标志物的AD精准诊断变得至关重要，而这种诊断曾经只在高度专业化的中心和研究环境中进行。患者选择很复杂，尽管已经发布了合理使用建议，但美国各地照顾AD患者的临床医生在试图使临床试验标准、合理使用建议与临床实际患者相匹配时仍面临不确定性。在这篇由美国神经精神协会痴呆症特别兴趣小组发表的关于这些疗法的两部分行为神经病学与神经精神病学治疗评论中，第1部分和第2部分分别讨论了患者选择中的实际问题以及AAT实施中的医疗保健和系统性挑战。
