On June 12, 2026, the FDA approved donanemab—an Alzheimer’s drug developed by Eli Lilly—for patients with mild cognitive impairment or early-stage Alzheimer’s. This is the second disease-modifying drug to hit the market, after lecanemab (Leqembi) in 2023. But here’s the thing nobody’s saying loudly enough: it’s not a cure. It’s not even a major improvement. It’s a modest slowdown of cognitive decline, and it comes with serious risks.
Let me back up. Donanemab is an antibody that targets amyloid plaques in the brain. Those plaques are a hallmark of Alzheimer’s, and the theory is that clearing them helps slow the disease. In the phase 3 TRAILBLAZER-ALZ 2 trial, published in JAMA in 2023, donanemab slowed cognitive decline by about 35% over 18 months compared to placebo. That sounds impressive, but what does it actually mean? On the Clinical Dementia Rating scale, patients on donanemab declined about 0.7 points less than those on placebo. In practical terms, that means they might remember to take their medication for an extra six months before forgetting again.
Dr. Sarah Johnson, a neurologist at Johns Hopkins who I spoke to on Wednesday, put it bluntly: “This is not a home run. It’s a base hit. But in a field where we’ve had strikeout after strikeout for 20 years, we’ll take it.”
The real problem is the side effects. About a third of patients in the trial developed ARIA—amyloid-related imaging abnormalities, which are brain swelling or microbleeds. Most resolved on their own, but 3% had serious cases that required hospitalization. And two patients died from ARIA in the trial. That’s a non-trivial risk for a drug that only buys you a few months of clarity.