Lecanemab, an anti-amyloid monoclonal antibody, received traditional approval from the US Food and Drug Administration (FDA) in July 2023 as the first disease-modifying treatment for Alzheimer’s disease (AD). However, its use is associated with risks such as amyloid-related imaging abnormalities (ARIA), which can present as brain swelling (ARIA-E) or small brain bleeds (ARIA-H). A recent study published on 12 May in the journal JAMA Neurology assessed the feasibility and safety of administering lecanemab in a real-world memory clinic setting. Conducted by researchers at Washington University in St. Louis, Missouri, the retrospective analysis included 234 patients with early symptomatic AD who received intravenous lecanemab at a dose of 10 mg/kg every two weeks between August 1, 2023, and October 1, 2024.
Overall, the study found that it is possible to treat patients with anti-amyloid antibodies with a relatively low rate of significant complications. Infusion-related reactions were common (37%) and typically mild. Among the 194 patients at risk for ARIA, 44 had at least one microhemorrhage and/or superficial siderosis before initiating lecanemab (23%). Over an average treatment period of 6.5 months, 42 patients (22%) developed ARIA; 29 developed ARIA-E with or without ARIA-H (15%), and 13 developed isolated ARIA-H (6.7%). Eleven patients (5.7%) experienced symptomatic ARIA, with two cases (1.0%) being clinically severe. No patients developed macrohemorrhages or died. Patients with mild dementia had a 27% rate of symptomatic ARIA; those with mild cognitive impairment or very mild dementia had a 1.8% rate.
https://jamanetwork.com/journals/jamaneurology/fullarticle/2833457
