Anti-amyloid Monoclonal Antibody and Acetylcholinesterase Inhibitor as Combination Therapy for Alzheimer Disease

Authors

• Ariel Lan, University of LynchburgFollow

Abstract

Anti-amyloid monoclonal antibodies (mAbs) offer novel disease-modifying potential for Alzheimer disease (AD), while acetylcholinesterase (AChE) inhibitors remain the standard of care for symptomatic management. Because these drug classes target distinct pathophysiologies—amyloid-beta accumulation and acetylcholine (ACh) deficiency, respectively—they are frequently co-prescribed. This clinical review synthesizes current literature from PubMed, Cochrane Library, and CINAHL Complete to evaluate the safety, efficacy, and rationale for combination therapy versus monotherapy. Clinical trials show that anti-amyloid mAb medications lecanemab and donanemab moderately slow early AD progression, though both carry risks of Amyloid-Related Imaging Abnormalities (ARIA), with lecanemab exhibiting a slightly favorable safety profile. While AChE inhibitors such as donepezil offer modest cognitive stabilization, direct empirical research evaluating their combination with anti-amyloid mAbs remains non-existent. Given that AChE inhibitor use was permitted in major anti-amyloid mAb clinical trials despite a lack of direct data, future research must explicitly investigate the synergistic efficacy, safety, and cost-effectiveness of combination therapy compared to monotherapy.

Recommended Citation

Lan A. Anti-amyloid Monoclonal Antibody and Acetylcholinesterase Inhibitor as Combination Therapy for Alzheimer Disease. University of Lynchburg Doctoral Project Assignment Repository. 2026; 8(3).