Initial Experience with Lecanemab and Lessons Learned in 71 Patients in a Regional Medical Center

Area of Science:

• Neurology
• Pharmacology
• Biomarkers

Background:

• Lecanemab (Leqembi®), an anti-amyloid monoclonal antibody, received FDA approval on July 6, 2023, for Alzheimer's disease (AD).
• This study details early clinical experiences with lecanemab at a community medical center.

Purpose of the Study:

• To describe the initial patient cohort treated with lecanemab for Alzheimer's disease.
• To report on the safety and tolerability of lecanemab in a real-world setting.
• To identify lessons learned for optimizing the lecanemab infusion process.

Main Methods:

• Retrospective observational study of the first 71 patients receiving lecanemab.
• Patients had confirmed AD biomarkers (CSF or amyloid PET).
• Data collected on demographics, comorbidities, ApoE4 genotype, prior AD medications, and adverse events.

Main Results:

• The cohort (mean age 72) had high rates of comorbidities and ApoE4 genotype (51% heterozygous, 13% homozygous).
• 24% of patients experienced amyloid-related imaging abnormalities (ARIA), with higher rates in ApoE4 homozygotes (44%).
• 37% reported infusion reactions; one death occurred, cause uncertain.

Conclusions:

• Early lecanemab use in a community setting revealed manageable safety concerns like ARIA and infusion reactions.
• ApoE4 genotype is a significant factor in ARIA development.
• Experience gained can refine and improve the lecanemab treatment protocol.