Yes, neurologists are actively using Kisunla (donanemab) in clinical practice, particularly in specialized memory care settings.
Donanemab received FDA approval in 2024 and is being implemented by neurologists and dementia specialists for treating early symptomatic Alzheimer's disease (mild cognitive impairment or mild dementia stage). 1, 2 The 2025 Alzheimer's Association guidelines explicitly acknowledge that "protocols and care pathways for lecanemab administration have made it available to patients, particularly in specialty clinical practices," and note that donanemab received unanimous FDA advisory panel recommendation for traditional approval in June 2024. 1
Current Real-World Implementation
Real-world data from a regional specialty medical center demonstrates active clinical use: 51 patients received at least one donanemab infusion between October 2024 and October 2025, with the study concluding that "donanemab may be safely used in a real-world setting with structured monitoring." 3 This confirms neurologists are not only prescribing it but have established monitoring protocols.
Practice Setting Requirements
Donanemab administration requires high proficiency and comprehensive multidisciplinary teams, which is why it's primarily being used in specialized care settings rather than general practice. 1 The guidelines emphasize that "providing treatment with amyloid plaque-lowering mAbs requires high proficiency and sufficient resources including close collaborations with comprehensive multidisciplinary teams." 1
Healthcare systems are actively developing infrastructure for administration, including:
- Hub-and-spoke models connecting specialists with primary care
- Infusion protocols and imaging surveillance systems
- Interprofessional collaboration frameworks 4
Patient Selection Criteria Neurologists Are Using
Appropriate candidates include:
- Mild cognitive impairment or mild dementia due to AD (MMSE 20-30)
- Biomarker confirmation of amyloid pathology (via PET or CSF)
- APOE genotyping performed prior to treatment to assess ARIA risk 5
Exclusion criteria being applied:
- More than 4 cerebral microbleeds on baseline MRI
- Cortical superficial siderosis
- Major vascular contribution to cognitive impairment
- Need for anticoagulation (relative contraindication) 5
Safety Monitoring Protocols in Practice
The real-world experience shows neurologists are implementing rigorous surveillance:
- ARIA detected in 20.8% of patients in the implementation cohort 3
- No symptomatic ARIA occurred in this cohort, demonstrating effective monitoring 3
- Surveillance MRIs performed prior to 2nd, 3rd, 4th, and 7th infusions 5
- APOE ε4 carriers showed higher ARIA rates (p=0.033), confirming the importance of genotyping 3
Discontinuation Rates
In real-world practice, 15.7% of patients discontinued donanemab due to:
- ARIA progression (5 patients)
- Severe infusion reactions (2 patients)
- Need for anticoagulants (1 patient) 3
This is consistent with the manageable safety profile described in guidelines.
Current Limitations and Workforce Challenges
A critical caveat: "Too few specialists currently available to respond to the possible number of patients who are candidates for treatment." 1 The guidelines acknowledge that the availability of disease-modifying therapies "may create a demand for timely detection, accurate diagnosis, and appropriate treatment options for early AD that could overwhelm an unprepared health-care system." 1
This means while neurologists ARE using donanemab, access remains limited and concentrated in specialized centers with the infrastructure to support:
- Monthly IV infusions
- Serial MRI monitoring
- Multidisciplinary team coordination
- Shared decision-making processes 5
Treatment Duration Approach
Neurologists are implementing a finite treatment course model: "Clinicians may consider discontinuing treatment if amyloid clearance is demonstrated by amyloid PET, typically obtained 12-18 months after initiating treatment." 5 This differs from indefinite therapy and requires biomarker-guided treatment decisions.
The bottom line: Donanemab is actively being prescribed and administered by neurologists in specialized memory care settings with established safety monitoring protocols, though access remains limited by workforce capacity and infrastructure requirements.