Leqembi & Kisunla
Lecanemab (Leqembi) & Donanemab (Kisunla™) — Anti-Amyloid Antibodies
Lecanemab and donanemab are the first drugs proven to slow Alzheimer's disease progression — not just manage symptoms. Both are IV monoclonal antibodies that clear amyloid-beta plaques from the brain. Lecanemab (approved July 2023) targets toxic protofibrils; donanemab (approved July 2024) targets a modified form of amyloid unique to plaques. Both require confirmed amyloid pathology and APOE4 genetic testing before use. They represent a historic milestone: for the first time, treating the underlying disease rather than its downstream effects. The tradeoff is a significant safety burden — brain swelling and microbleeds occur in a meaningful fraction of patients, and the absolute cognitive benefit, while real, is modest at 18 months.
How to read this sphere
The percentage on each node is the confidence level that a particular benefit or side effect is actually real — higher means more high-quality studies back it up. Once confidence crosses ~80%, the effect is considered Pacified: generally accepted as true by the scientific community.
Position reflects confidence: nodes closer to the center have stronger evidence; nodes near the edge are still speculative. As more studies are published, nodes migrate inward — or disappear entirely if the evidence collapses.
These are new drugs — both approved 2023–2024. The pivotal trials ran for only 18 months, so this sphere reflects the earliest chapter of what will be a decades-long evidence story. The ARIA safety nodes are well-established; the cognitive benefit nodes will likely shift inward as longer-term data emerge. Watch this sphere change.
All Sources
- CLARITY AD: Lecanemab in Early Alzheimer's Disease↗New England Journal of Medicine2023re: Cognitive Decline Slowing
- TRAILBLAZER-ALZ 2: Donanemab in Early Symptomatic Alzheimer Disease↗JAMA2023re: Cognitive Decline Slowing
- Lecanemab Phase 2: Detailed Biomarker, Cognitive, and Clinical Results↗Alzheimer's Research & Therapy2022re: Cognitive Decline Slowing
- TRAILBLAZER-ALZ Phase 2: Donanemab in Early Alzheimer's Disease↗New England Journal of Medicine2021re: Cognitive Decline Slowing
- Modified Titration of Donanemab Reduces ARIA Risk and Maintains Amyloid Reduction↗Alzheimer's & Dementia2025re: ARIA-E: Brain Edema
- Lecanemab Phase 2: Consistency of Efficacy Across Clinical Measures and Statistical Methods↗Alzheimer's Research & Therapy2022re: Modest Absolute Benefit
- Risk Factors in Developing Amyloid Related Imaging Abnormalities (ARIA) and Clinical Implications↗Frontiers in Neuroscience2024re: APOE4: Dramatically Higher Risk
- Influence of Patient Characteristics on Efficacy and Safety of Anti-Amyloid Monoclonal Antibodies: Meta-Analysis↗Ageing Research Reviews2026re: APOE4: Dramatically Higher Risk
- Antibody-Mediated Clearance of Brain Amyloid-β: Mechanisms of Action↗Journal of Alzheimer's Disease Reports2023re: Amyloid Plaque Clearance
- Updated Safety Results from Phase 3 Lecanemab Study in Early Alzheimer's Disease↗Alzheimer's Research & Therapy2024re: ARIA-E: Brain Edema
- Amyloid-Related Imaging Abnormalities with Donanemab in Early Symptomatic Alzheimer's Disease↗JAMA Neurology2025re: ARIA-E: Brain Edema
- Six-Month Follow-Up of ARIA-H and Iron Deposition in Real-World Lecanemab Therapy↗Alzheimer's & Dementia2026re: ARIA-H: Microhemorrhages
- ARIA in Japanese Patients with Alzheimer's Disease Treated with Lecanemab: A Real-World Study↗Journal of Prevention of Alzheimer's Disease2026re: APOE4: Dramatically Higher Risk
- Lecanemab: Appropriate Use Recommendations↗Journal of Prevention of Alzheimer's Disease2023re: APOE4: Dramatically Higher Risk
- Assessing the Clinical Meaningfulness of Slowing CDR-SB Progression in Alzheimer's Disease↗Alzheimer's & Dementia (New York)2025re: Functional Decline Slowing
- Real-World Implementation of Lecanemab and Donanemab in an Italian Memory Center: A 1-Year Experience↗Alzheimer's Research & Therapy2026re: Infusion Reactions
- Donanemab: Appropriate Use Recommendations↗Journal of Prevention of Alzheimer's Disease2025re: Anticoagulant Danger
- Donanemab in Early Symptomatic Alzheimer's Disease: Results from the TRAILBLAZER-ALZ 2 Long-Term Extension↗Journal of Prevention of Alzheimer's Disease2026re: Benefit Persists After Stopping
- Posttreatment Amyloid Levels and Clinical Outcomes Following Donanemab for Early Symptomatic Alzheimer Disease↗JAMA Neurology2025re: Benefit Persists After Stopping
- Amyloid Immunotherapy for Alzheimer's Disease: The Case for Cautious Adoption↗Arquivos de Neuro-Psiquiatria2025re: Modest Absolute Benefit
- Lifetime Cost-Effectiveness of Lecanemab for Early Alzheimer's Disease↗Frontiers in Public Health2026re: High Cost & Access Barriers
- Cost-Effectiveness of Diagnosing and Treating Patients with Early Alzheimer's Disease with Anti-Amyloid Treatment↗Journal of Alzheimer's Disease2025re: High Cost & Access Barriers
Last updated: 2026-05-09 · Data compiled from PubMed, ClinicalTrials.gov, FDA, and EMA databases.