Donanemab: A comprehensive review of mechanism, clinical efficacy, and safety in early stage Alzheimer’s disease therapy

Alzheimer’s disease is a progressive neurodegenerative disease and the main cause of dementia worldwide. It affects cognitive decline, functional impairment and a significant burden on socjety. For many years, available treatments focused on reducing symptoms and did alter the underlying neurodegenerative process. Recent advances in drug develepment show that there are real possibilities for disease-modifying therapies that will target pathomechanisms such as β-amyloid deposition. The following review narrates the current knowledge about donanemab, a humanized monoclonal antibody targeting N-terminal pyroglutamate-modified amyloid-β, focusing on its mechanism of action, pharmacokinetics, clinical efficacy, and safety profile. The review was based on published results of clinical trials and review articles identified in medical databases. Donanemab promotes microglia-mediated clearance of amyloid plaques by binding to dense-core amyloid plaques. Additionally, it reduces plasma concentrations of phosphorylated tau 217 and glial fibrillary acidic protein (GFAP). Pharmacokinetic studies show predictable, dose-dependent exposure after intravenous administration. In Phase II and III clinical trials donanemab treatment resulted in significant reduction in cognitive and functional decline. Positron emission tomography (PET) imaging showed substantial amyloid reduction and changes in plasma and cerebrospinal fluid biomarker levels. The most common adverse event was amyloid-related imaging abnormalities (ARIA), but most cases were asymptomatic and resolved after treatment adjustment. Compared with other anti-amyloid monoclonal antibodies, donanemab achieves more rapid and complete amyloid clearance than aducanumab and shows similar disease-modifying activity to lecanemab. Ongoing research on emerging therapies for Alzheimer’s disease may lead to further breakthroughs in disease treatment.