Critical Appraisal of Amyloid Lowering Agents in AD

Purpose of Review According to the amyloid cascade hypothesis, removing amyloid beta (A beta) should cure Alzheimer's disease (AD). In the past three decades, many agents have been tested to try to lower A beta production, prevent A beta aggregation, and dissolve A beta deposits. However, the paucity in definitive preventative or curative properties of these agents in clinical trials has resulted in more avant-garde approaches to therapeutic investigations. Immunotherapy has become an area of focus for research on disease-modifying therapies for neurodegenerative diseases. In this review, we highlight the current clinical development landscape of monoclonal antibody (mAb) therapies that target A beta plaque formation and removal in AD. Recent Findings Multiple potential disease-modifying therapeutics for AD are in active development. Targeting A beta with mAbs has the potential to treat various stages of AD: prodromal, prodromal to mild, mild, and mild to moderate. Monoclonal antibodies discussed here include aducanumab, lecanemab, solanezumab, crenezumab, donanemab, and gantenerumab. The final decision by the FDA regarding the approval of aducanumab will offer valuable insight into the trajectory of drug development for mAbs in AD and other neurodegenerative diseases. Future directions for improving the treatment of AD will include more inquiry into the efficacy of mAbs as disease-modifying agents that specifically target A beta peptides and/or multimers. In addition, a more robust trial design for AD immunotherapy agents should improve outcomes such that objective measures of clinical efficacy will eventually lead to higher chances of drug approval.

Automated summary

According to the amyloid cascade hypothesis, removing amyloid beta (A beta) is believed to cure Alzheimer's disease (AD), but current clinical trials lack definitive efficacy. Therefore, research has shifted focus towards immunotherapy, particularly monoclonal antibody therapies targeting A beta plaques. This approach offers potential for treating different stages of AD and may provide valuable insights into the trajectory of drug development for neurodegenerative diseases.