Anti-amyloid therapies: real-world data and pipeline expansion

Lecanemab at-home injection approved; real-world Duke data shows 80% adherence, 24% ARIA. Donanemab expanding to Lewy body; trontinemab Phase 3 recruiting. VY1706 gene therapy shows 75% tau reduction preclinically. Access and ARIA management remain challenges. New breakthrough: microglia, not plaques, drive sleep loss in Alzheimer's; depleting immune cells restores sleep in mice—paradigm shift for neuroinflammation-targeted therapies. New: GRK2 aggregation identified as novel target; Compound 10 breaks cycle in mice. Observational study links NOACs to modestly slower cognitive decline in Alzheimer's with AFib. Comprehensive 2026 pipeline review from PMC.