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

This article focuses on a systematic review and network meta-analysis comparing the efficacy, tolerability, and acceptability of repetitive transcranial magnetic stimulation (rTMS) with three U.S. Food and Drug Administration (FDA)-approved anti-amyloid beta (Aβ) antibody therapies—aducanumab, lecanemab, and donanemab—in treating mild cognitive impairment (MCI) and early Alzheimer's disease (AD). Analyzing 19 randomized placebo-controlled trials involving 6,918 participants, the study found that rTMS demonstrated significantly greater cognitive benefits and better tolerability and acceptability than the antibody therapies, which showed limited efficacy and more adverse effects. The findings suggest that rTMS, a non-pharmacological intervention with potential neuroplastic and disease-modifying effects beyond Aβ removal, may offer a safer and more effective alternative, though long-term direct comparison studies are needed to confirm these results. The study also highlights the high cost and safety concerns associated with anti-Aβ antibody treatments and calls for further research into diverse therapeutic approaches beyond the amyloid hypothesis.