Amyloid Targeting Therapies
Donanemab & Lecanemab
A NEW advancement in the TREATMENT
of alzheimer's disease
“As a cognitive neurologist who has been seeing patients with Alzheimer's disease for over a decade, I am thrilled to be able to offer patients diagnosed with early-stage Alzheimer’s disease the latest in effective treatment options to slow the progression of the disease."
"While previous treatments only ease symptoms, these newly licensed drugs can now slow the disease’s progression for certain patients. Clinical trials showed Donanemab (Kisunla™) reduced the rate of cognitive decline by up to 37% . Access to comprehensive treatment programmes, like the one we have established at London Bridge Hospital, can greatly impact patients’ journeys.”
Dr Johnathan Chan
Consultant Neurologist and Dementia Specialist
What are Amyloid Targeting Therapies (ATT)?
Amyloid Targeting Therapies are the first in a class of new disease-modifying drugs for the treatment of Alzheimer’s disease. For the first time in therapeutic history, we now have pharmaceutical treatments that directly impact on the underlying pathological mechanisms in the brain that cause progression of the condition.
In the development of Alzheimer's disease, a protein known as amyloid beta accumulates abnormally in the brain to form amyloid plaques. This process usually occurs slowly for over a decade before a person starts to develop symptoms of cognitive dysfunction.
ATTs are a form of monoclonal antibody treatment (proteins that helps your immune system target specific proteins for removal) designed to help remove amyloid beta protein from the brain. Two ATTs, Donanemab and Lecanemab, that have been approved for clinical use in the treatment of Alzheimer's disease, have been found to be very effective in removing amyloid beta from the brain.
At the moment, Amyloid Targeting Therapies are only given to people at the early stages of Alzheimer's disease. They are not currently a cure for Alzheimer’s disease. However, at the early stages, they are shown to modestly slow the rate of progression in patients with mild cognitive impairment (MCI-AD) or early-stage dementia caused by Alzheimer’s disease (mild AD). After an 18-month course of treatment, currently available Amyloid Targeting Therapies can slow the rate of progression of your symptoms by up to one third (35%).
It is important to understand that although they have been demonstrated to delay the progression of the condition, this does not mean that you are going to experience in yourself an improvement in your current symptoms whilst on these treatments. Your condition will continue to progress, although at a slower rate than if you are not taking the treatment.
Why do ATTs not completely stop the progression of Alzheimer's disease if they are able to clear amyloid plaques so effectively?
Although amyloid beta protein is an essential protein in the development of Alzheimer's disease, there is a second protein, Tau, that is also involved in the progression of the condition.
When amyloid beta plaques accumulate beyond a certain amount after a certain number of years, it leads to the abnormal accumulation of Tau protein. It is this Tau protein that causes the degeneration of brain neurons that eventually leads to the development of cognitive impairment and memory loss. As such, by the time someone has developed symptoms of Alzheimer's disease, Tau is already abnormally present in the brain. This means that although ATTs clear amyloid completely from the brain, the best that this can currently achieve is to slow down the accumulation of Tau, and in doing so, slow down the progression of clinical symptoms.
Did a recent review conclude that ATTs are not clinically effective?
Yes, a 2026 Cochrane review did indeed conclude that Amyloid Targeting Therapies did not produce clinically meaningful effects in patients with early Alzheimer's Disease. However, since the publication of this review, it has prompted strong responses from many esteemed clinicians and researchers in the field of Alzheimer's disease treatment and research to point out the significantly flawed methodology used in the analysis.
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You can find here the official statements from:
Essentially, the authors of the Cochrane review decided to select 17 studies for analysis. Two of these studies were for Lecanemab and Donanemab. These are the two ATTs approved by many regulatory bodies around the world due to their robust clinical trial results. The trials for these two treatments demonstrated not only excellent amyloid beta clearance in the brain, but also clear clinical benefits in people on the treatment when compared with people on a placebo.
The other 15 studies selected by the authors were for 5 other previous ATTs that failed to achieve fast and effective amyloid clearance, or failed to demonstrate any significant clinical benefit over placebo, or both. It is important to be aware that these 5 other drugs were summarily abandoned by the scientific community due to their lack of clinical effect, as the search went on to find better and more effective drugs.
As such, if one were to take 2 clinically effective drugs and add them to a mixture of 5 other ineffective drugs, it is therefore hardly surprising to find that the average result would be that none of the drugs show effectiveness. This would be similar to taking the heights of 2 tall people, adding them to the heights of 5 short people, taking the average result, and then coming to the conclusion that there are no tall people in the room. Understanding this methodology might help you understand why this review has come under significant criticism.
To review the methodology of the Cochrane analysis for yourself, you can find it here.
To review the scientific findings of the two robust clinical trials for Donanemab and Lecanemab, you can find these here.
Donanemab - TRAILBLAZER-ALZ 2
Lecanemab - CLARITY-AD
Amyloid seen on a PET scan
DONANEMAB and LECANEMAB
These are the two Amyloid Targeting Therapies currently approved in the UK since early 2025, for the treatment of MCI-AD or mild AD. At present, these are only available privately as they have not been approved for use in the NHS due to the costs of these treatments.
These treatments are also not currently reimbursed by private medical insurance and are available only as self-pay treatments.
Contact us if you would like to find out more about accessing these treatments in the UK under Dr Chan through our Alzheimer's Disease Treatment Programme at HCA Healthcare at London Bridge Hospital.
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Donanemab (Kisunla™)
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Lecanemab (Leqembi®)
What does treatment with
Donanemab or Lecanemab involve?
What is the benefit of having Amyloid Targeting Therapy?
Both Donanemab and Lecanemab have been demonstrated in large double-blinded placebo-controlled clinical trials to reduce the speed of progression of clinical symptoms in early Alzheimer's Disease.
It is important to be aware that your current symptoms are not expected to improve following this treatment. However, the speed at which your cognitive decline progresses is expected to be 30-35% slower. For example, over a 3-year period, you will only be expected to have progressed for 2 years as compared to if you did not have the treatment. Having the treatment therefore gives you back more time, where you are able to function better for longer.
Although the original trials for both of these treatments were only for 18-month durations, there is now more published data from ongoing review of these patients up to 3 years for Donanemab, and up to 4 years for Lecanemab. Crucially, the benefits of these treatments continue to accrue well beyond the initial trial period of 18 months. In particular, for patients who had treatment with Donanemab, the degree of reduction in clinical progression is maintained despite most patients on the original trial having stopped all treatment at 18 months.
For long term data showing sustained incremental benefits of Donanemab and Lecanemab years after the completion of the original trials, you can find these here.
Donanemab Long Term Extension Trial
Lecanemab Open Label Extension Trial
How is the treatment given?
Both Donanemab and Lecanemab are given as intravenous infusions and this is done as a day-case visit in an infusion suite at the London Bridge Hospital.
Each infusion takes up to an hour. How regularly you have the infusion depends on which treatment you choose:
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If you are on Donanemab, you’ll have an infusion every four weeks.
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If you are on Lecanemab, you’ll have an infusion every two weeks.
How long do I have to be on treatment?
If you are on Donanemab, you will only have a maximum of 18 months of treatment. If you have a repeat Amyloid PET scan at 6 or 12 months that shows sufficient clearance of amyloid protein in your brain, you can also stop the treatment then.
If you are on Lecanemab, you will continue with this treatment for 18 months. After 18 months, you will switch to maintenance treatment which is given every 4 weeks and you will remain on treatment unless you progress to a moderate stage of Alzheimer's disease.
What are the risks of treatment?
Amyloid-targeting therapies can cause a side effect known as amyloid related imaging abnormalities, or ARIA for short. ARIA involve leakiness of the blood vessels in your brain which leads to brain bleeding or swelling, or a combination of both.
Your risk of ARIA depends on a gene known as the APOE gene. People with two copies of the E4 version of this gene are at a much higher risk of ARIA than people who have only one or no copies of the gene. In the UK, the MHRA has disallowed the use of amyloid-targeting therapies in people with two copies of the APOE4 gene version to significantly reduce the risks of treatment. Before starting on treatment, we’ll carry out a genetic test to make sure you have either one or no copies of the e4 gene to check that you are able to have the treatment.
The majority of people undergoing treatment will not develop any problems on it. If you do not have two copies of the E4 gene version, although up to 1 in 3 people can develop ARIA, only 3 in 50 people will develop symptoms from it and less than 1 in 50 people will have serious complications from it.
In the majority of cases, if it does arise, ARIA is very mild and does not cause any symptoms. This is why as part of your treatment, it is also necessary for for you to have regular MRI scans during the first 6 months of treatment to screen for ARIA as this is when it is most likely to occur.
At London Bridge Hospital, you can also be assured that we adhere strictly to published international consensus guidance protocols on the monitoring for, and the management of any potential ARIA that might arise during the course of treatment. Your treatment will also be overseen by a Multidisciplinary Team of Neurologists, Neuroradiologists and Nuclear Medicine Specialists.
What tests do I need before I can start on treatment?
Unless you have already had these done, you are likely to require the following tests before we know that you qualify for treatment:
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Amyloid PET scan.
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APOE gene test.
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Baseline pre-treatment MRI brain scan.
Can there be reasons that make me unsuitable for these treatments?
Yes. As mentioned, if your genetic status shows that you have two E4 versions of the APOE gene, you will not be able to have this treatment in the UK. Other reasons that affect your eligibility for these treatments include being on anticoagulation medication (warfarin, apixaban, rivaroxaban, edoxaban, dabigatran), having persistently uncontrolled blood pressure, and having a cardiac pacemaker, amongst a range of criteria that you need to meet. You must also only be in the early stage of Alzheimer's disease as the treatment is not suitable for people who are already in the moderate or late stages of the condition.
How much does the treatment cost?
A full 18-month course of treatment will cost approximately in the region of £100,000. The majority of this cost is due to the cost of the medication and also the use of the infusion facilities.
However, if you are on treatment with Donanemab, and if you demonstrate complete clearance of amyloid protein after either 6 or 12 months of treatment, the total cost will be proportionately less.
Do you offer treatment at home?
Yes, we do. However, this option is reserved only for patients who have to travel from other parts of the UK into London for their treatment. This is to help improve treatment accessibility for patients living farther away. In this situation, home treatment can be offered after you have completed the first 6 months of your treatment at London Bridge Hospital. This is because the risk of any treatment side effect becomes very low after you have completed the first six months of treatment.
Our home treatment service is delivered by Sciensus, a large and well-established home treatment delivery service that has a long track record of delivering a range of complex infusions, including chemotherapy treatments, to patients' homes in the UK and in Europe. You can learn more about Sciensus here.
Do you accept overseas patients for treatment?
Yes, we do. However, this depends on the country you are from and we recommend that you enquire about this directly with us before booking your appointment. We currently have a number of overseas patients regularly undergoing these treatments with us at London Bridge Hospital. Home treatment is unfortunately not possible for patients living overseas due to restrictions imposed by clinical regulations that exist within individual countries.
WHAT ASSESSMENT DO I NEED?
1
Preliminary Screening
Virtual Appointment
If you simply want to find out more about treatment with Donanemab or Lecanemab and if you might be a suitable candidate, we will arrange for a 30-minute virtual appointment to provide you with a sense of what the treatment entails and to screen for any pre-existing conditions that might prevent you from having the treatment.
Duration: 30 minutes
Location: Virtual
Cost: £260
2
Comprehensive Eligibility Assessment for
Amyloid Treatments
This is a comprehensive 75-minute in-person assessment which will involve measuring your current level of cognitive functioning, and determine if you have completed all of the necessary tests required before knowing if you are suitable for Amyloid Targeting Treatments. It will also provide you with comprehensive knowledge of all the risks and benefits of these treatments for you to come to an informed decision.
Duration: 75 minutes
Location: London Bridge Hospital
Cost: £630
3
Diagnostic Appointment
If you have memory symptoms, but you have not been formally diagnosed with Alzheimer's disease, you can arrange for a 75-minute diagnostic consultation which includes a testing of your cognitive function. You might require further tests following the consultation to help confirm the diagnosis.
Duration: 75 minutes
Location: London Bridge Hospital
Cost: £630
WHAT OUR PATIENTS sAY
Mrs N, Kent, UK
"As you can imagine, I’m overjoyed that the treatment has been so successful, so quickly. I am sure that one of the reasons is that the symptoms were caught so early. I knew that things were not right, read a lot about the onset of Alzheimer’s and knew that I had to get tested. My GP confirmed the concern and I am so glad that he referred me to you."
“You have always explained everything so clearly, the diagnosis, the possible outcomes, the risks involved and the treatment trail. We felt that we really understood the position and so found it easy to make the decision, to go with Donanemab."
Above all, we were so pleased to have you as our consultant, kind, positive, clear, and caring. I would urge anyone with concerns to seek help early, and take the plunge with confidence."
HCA London bridge hospital
All of your dementia assessments and treatments will be carried out at London Bridge Hospital, a distinguished centre for excellence in healthcare in the centre of London, and part of the HCA Healthcare UK network of private hospitals.
Learn more about the similarities and differences between Dementia and Alzheimer's Disease.
Find out more about our delivery of Amyloid Targeting Treatments at London Bridge Hospital.
See our press releases on the new Amyloid Targeting Treatments:
Donamemab and Lecanemab.
