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Lecanemab appropriate use recommendations for clinical practice in the UK
Catherine J Mummery1, Jill Rasmussen2, Dan Blackburn3
1National Hospital for Neurology and Neurosurgery, University College London, London, England, UK cath.mummery@nhs.net.
Journal of Neurology, Neurosurgery, and Psychiatry
|December 13, 2025
Summary
Lecanemab, an anti-amyloid antibody, is now approved in the UK for early Alzheimer's disease (AD). Recommendations focus on safety, eligibility criteria including APOE4 status, and monitoring for adverse events like ARIA.
Area of Science:
- Neurology
- Pharmacology
- Geriatrics
Background:
- Lecanemab, an anti-amyloid monoclonal antibody, has received UK approval for treating mild cognitive impairment (MCI) and mild dementia due to Alzheimer's disease (AD).
- The drug is indicated for patients who are apolipoprotein E ε4 gene (APOE4) heterozygotes or non-carriers.
- This approval necessitates clear guidelines for its safe and effective implementation in UK clinical practice.
Purpose of the Study:
- To establish UK-specific recommendations for the appropriate use of lecanemab in clinical practice.
- To prioritize patient safety in the administration and monitoring of lecanemab treatment.
- To outline eligibility criteria and management strategies for lecanemab therapy.
Main Methods:
- A consensus panel of UK neurologists, old age psychiatrists, and geriatricians convened to develop recommendations.
- Recommendations detail eligibility screening, including clinical diagnosis, amyloid pathology confirmation (PET or CSF), and APOE4 status.
- Guidance covers lecanemab administration, required brain MRI monitoring (pre-infusions 1, 5, 7, 14), and management of adverse reactions.
Main Results:
- Established clear eligibility criteria for lecanemab: diagnosis of MCI/mild AD, confirmed amyloid pathology, and APOE4 non-carrier or heterozygous status.
- Defined a structured approach for screening and referral to specialist centers for confirmation, APOE4 counseling, and multidisciplinary decision-making.
- Provided specific protocols for lecanemab administration, including infusion frequency and a schedule for brain MRI scans to monitor for potential abnormalities.
Conclusions:
- The introduction of lecanemab offers a significant advancement in Alzheimer's disease treatment in the UK.
- Adherence to safety monitoring and management protocols is crucial for optimizing lecanemab therapy.
- These recommendations aim to ensure safe and effective use of lecanemab, potentially improving care for individuals with early AD.
