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How safe is clinic lecanemab in practice?

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Among 234 memory-clinic patients on lecanemab, infusion reactions (37%) and ARIA (22%) were common but generally manageable; mild dementia had much higher symptomatic ARIA.

Source

Lecanemab Treatment in a Specialty Memory Clinic

Paczynski M, Hofmann A, Posey Z, et al. · JAMA neurology · 2025

doi.org/10.1001/jamaneurol.2025.1232Read the full paper ↗76 citationscc by

Study at a glance

Design
Cohort — Retrospective consecutive case series of specialty-clinic lecanemab initiations
N
N=234 · Patients with early symptomatic AD receiving ≥1 infusion
Population
Early symptomatic Alzheimer disease patients at Washington University Memory Diagnostic Center
Outcome
Infusion reactions, ARIA (including symptomatic), and treatment withdrawal

Structured fields used in claim comparison tables when every cited study has a complete layer.

What they did

Reviewed consecutive lecanemab starts (Aug 2023–Oct 2024), dosing every 2 weeks, MRI monitoring, and adverse events through Dec 2024.

What they found

IRR 37%; ARIA 22% (ARIA-E 15%, isolated ARIA-H 6.7%); symptomatic ARIA 5.7% overall but 27% in mild dementia vs 1.8% in MCI/very mild; 9.8% withdrew (4.3% for ARIA); no macrohemorrhage/death.

The limits

What it doesn't show

Long-term efficacy vs placebo in this clinic sample, or risk under every eligibility exception.

Key terms

Lecanemab
Anti-amyloid monoclonal antibody for early symptomatic AD.
ARIA
Amyloid-related imaging abnormalities (edema/hemorrhage).
ARIA-E / ARIA-H
Edema/effusion vs hemorrhagic ARIA subtypes.
CDR
Clinical Dementia Rating of functional severity.
Appropriate use recommendations
Clinic eligibility guidance beyond the FDA label.
Infusion-related reaction
Acute reaction during/after IV dosing.

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Clinic lecanemab initiations reported?

Common questions

N treated?

234.

ARIA rate?

~22% of at-risk patients.

Who had more symptomatic ARIA?

Mild dementia (27%) vs MCI/very mild (1.8%).

Deaths/macrohemorrhage?

None in this report.

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