Anticorpos monoclonais anti-β-amiloide na Doença de Alzheimer

Eficácia clínica, limitações e implicações para a prática terapêutica

Abstract

Alzheimer’s disease (AD) is the leading cause of dementia worldwide, characterized by progressive cognitive decline and functional impairment. In recent years, the development of disease-modifying therapies has become a major focus, particularly monoclonal antibodies targeting β-amyloid, which aim to reduce cerebral amyloid plaque deposition. This study aims to critically analyze recent scientific evidence regarding the efficacy and safety of anti-β-amyloid monoclonal antibodies, focusing on aducanumab, lecanemab, and donanemab, as well as to discuss their limitations and implications for clinical practice. This is an integrative literature review conducted using the PubMed, Scopus, and ScienceDirect databases. Clinical studies were primarily identified through PubMed using controlled descriptors (MeSH Terms) combined with Boolean operators, prioritizing phase II and III randomized controlled trials and systematic reviews. Additional studies were included for theoretical contextualization. A total of seven studies were selected for qualitative analysis. The findings indicate that anti-β-amyloid monoclonal antibodies significantly reduce cerebral amyloid burden and produce statistically significant slowing of cognitive decline, particularly in early stages of the disease. However, the observed clinical benefit remains modest, with limited impact on functional outcomes. Furthermore, adverse events such as Amyloid-Related Imaging Abnormalities (ARIA) represent an important challenge for the safety and implementation of these therapies.In conclusion, although these therapies represent a significant advancement in AD treatment, their clinical impact remains quantitatively modest and is associated with challenges related to safety, cost, and large-scale implementation. Their role in clinical practice will depend on long-term evidence and the development of combined therapeutic approaches addressing the multifactorial nature of the disease.