Renji cognitive team releases the first domestic and international recommendations for sequential-like management of anti-aβ monoclonal antibody therapy in Alzheimer’s disease
image: With the increasing clinical use of anti-amyloid-β monoclonal antibodies in Alzheimer’s disease in China, some patients have completed or are approaching the predefined treatment period, leading to emerging clinical questions regarding post-treatment maintenance, discontinuation, monitoring, and retreatment. However, no consensus has yet been established on long-term management or sequential-like treatment strategies after anti-amyloid-β monoclonal antibody therapy. Based on current clinical evidence and the practical experience of Renji Cognitive Center, this article proposes an experience-based protocol for sequential-like management of anti-amyloid-β monoclonal antibody therapy. The protocol uses amyloid PET-derived Centiloid values as the core objective reference and recommends stratified management according to clinical clearance status and prior amyloid clearance rate. This protocol is intended to provide a clinical reference and requires further validation and optimization through real-world studies and long-term follow-up.
Credit: GENG Jieli, ZHI Nan, SONG Yaying, CAO Wenwei, WANG Liling, XIAO Jinwen, LI Haixia, JI Chenhui, WANG Jintao, LI Jianping, LI Shuang, HU Yiying, MIN Shurui, ZHANG Bei, WANG Hualong, WANG Gang.
Recently, the cognitive team led by Professor Gang Wang at Renji Hospital, Shanghai Jiao Tong University School of Medicine, officially published Recommendations for Sequential-like Management of Anti-amyloid-β Monoclonal Antibody Therapy in Alzheimer's Disease: An Experience-based Protocol from Renji Cognitive Center (2026) in the Journal of Neurology and Neurorehabilitation (https://jnnr.renji.com/CN/10.12022/jnnr.2026-0156). To the best of our knowledge, this is the first systematic recommendation both in China and internationally, to focus on long-term management and sequential-like treatment strategies following anti-Aβ monoclonal antibody therapy for Alzheimer's disease. Dr. Jieli Geng (Department of Neurology, Renji Hospital) is the first author, and Professor Gang Wang is the corresponding author. During the development of this protocol, the team received valuable suggestions and support from internal experts at Renji Hospital and relevant experts across China.
Since 2024, anti-Aβ monoclonal antibodies including lecanemab and donanemab have been gradually introduced into clinical practice across China. A growing number of patients have completed or are approaching the completion of their scheduled treatment cycles, raising new clinical challenges: whether to maintain therapy post-treatment, when to discontinue treatment, how to implement follow-up monitoring, and when to restart antibody intervention. Nevertheless, there remains a lack of unified consensus and directly applicable management pathways for this clinical scenario both in China and internationally.
Integrating available clinical research evidence and real-world experience accumulated at the Renji Cognitive Center, these recommendations establish a stratified management framework centered on Centiloid quantitative values derived from amyloid positron emission tomography (PET). Clinical amyloid clearance status, historical Aβ clearance rate and individual patient conditions are incorporated for tailored intervention. The protocol recommends dynamic monitoring combining plasma p-tau217 and amyloid PET after treatment discontinuation. A repeated rise of Centiloid value above 24.1 CL is identified as a key reference indicator for clinicians to consider restarting anti-Aβ monoclonal antibody therapy.
These recommendations provide an initial framework for long-term care following anti-Aβ monoclonal antibody treatment, and lay a foundation for subsequent real-world studies and consensus development. Moving forward, the Renji Cognitive Team will continue to refine full-cycle management strategies for Alzheimer’s disease disease-modifying therapies by incorporating long-term follow-up data and real-world evidence from Chinese populations, based on clinical experience with three anti-Aβ monoclonal antibodies. The team aims to contribute Renji’s clinical insights to domestic and international clinical guidelines and consensus statements for Alzheimer’s disease.