J Psychpharmacol

Anti-amyloid drugs vs. rTMS: Which improves cognition more in early Alzheimer’s?

May 30, 2025

Study details: This systematic review and network meta-analysis evaluated the comparative efficacy, tolerability, and acceptability of aducanumab, lecanemab, donanemab, and repetitive transcranial magnetic stimulation (rTMS) on cognitive function in patients with mild cognitive impairment (MCI) and mild Alzheimer’s disease (AD). Nineteen randomized placebo-controlled trials with 6,918 participants were included.

Results: rTMS demonstrated significantly greater efficacy in improving cognitive function compared with placebo/sham and was also superior to aducanumab, lecanemab, and donanemab. In terms of tolerability and acceptability, rTMS wasn’t inferior to placebo/sham, while all three monoclonal antibodies were significantly less tolerable and acceptable than placebo/sham. rTMS was also superior to lecanemab and donanemab in acceptability. No significant differences were observed among the monoclonal antibodies themselves.

Clinical impact: Despite regulatory approval, aducanumab, lecanemab, and donanemab may offer limited cognitive benefit compared with non-pharmacologic interventions like rTMS. These findings suggest a need to re-evaluate treatment strategies in early AD, especially considering cost, side effects, and patient adherence.

Source:

Terao I, et al. (2025, May 19). J Psychopharmacol. Comparative efficacy, tolerability, and acceptability of aducanumab, lecanemab, and donanemab with repetitive transcranial magnetic stimulation on cognitive function in mild cognitive impairment and Alzheimer's disease: A systematic review and network meta-analysis. https://pubmed.ncbi.nlm.nih.gov/40386876/