Use of Donanemab in Early Symptomatic Alzheimer Disease—Reply

In Reply Amyloid-related imaging abnormalities are a common adverse event for individuals with Alzheimer disease receiving amyloid-targeting therapies. In their Letter, Drs Pomara and Imbimbo thoughtfully explore the possibility that APOE-mediated breakdown of the blood-brain barrier could lead to increased concentrations of donanemab in the CSF and thus increase incidence of amyloid-related imaging abnormalities (edema and effusions). This hypothesis is important to consider.