This review examines therapeutic plasma exchange (TPE) as a disease-modifying strategy in Alzheimer's disease (AD), covering the AMBAR trial, earlier pilot studies, real-world cohort evidence, and mechanistic comparisons with anti-amyloid monoclonal antibodies.
TPE is presented as a broadly acting, biologically rational therapy that contrasts with selective anti-amyloid monoclonal antibodies by targeting multiple AD pathways — including immune dysregulation, oxidative stress, vascular injury, impaired protein clearance, and synaptic dysfunction — with supporting evidence from the AMBAR trial and real-world cohort data.
This is a narrative review incorporating the author's personal clinical experience, which introduces potential bias. No new primary trial data or head-to-head comparative efficacy figures are reported. Real-world cohort evidence is discussed but not systematically synthesized.
TPE may offer a multi-mechanistic approach to AD that complements or contrasts with anti-amyloid antibody therapies; clinicians managing AD patients should be aware of the evolving real-world evidence base for TPE as an outpatient, chronic disease-management strategy.
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