Anti-Amyloid Monoclonal Antibody Therapy

You will see a lecanemab neurologist to:

• Review your medical history and medications
• Do a neurologic exam 
• Order a blood test for your APOE genotype
• Order an MRI if not done recently

You will meet with a neuropsychologist to: 

• Discuss your memory in detail
• complete cognitive tests of your thinking and memory. 

This evaluation will help us to better understand your memory problem.

Before receiving lecanemab, it is important to understand potential side effects of the medication. Two main concerns while receiving lecanemab are infusion reactions, and brain bleeding and swelling.

Infusion Reactions

Infusion reactions occur when your body and immune system reacts to a treatment that is given intravenously (IV). Lecanemab is a treatment that can cause infusion reactions.

• Infusion reactions are typically mild-moderate and occur during or after the first few infusions. Symptoms usually resolve on their own within 24 hours and can be managed at home.
• You will be monitored for any reactions. If you have a reaction, you may be treated with medications and your infusion stopped. 
• Symptoms that can be associated with infusion-related reactions:
  • Fever
  • Flu-like symptoms
  • Rash
  • Nausea, vomiting
  • Dizziness or lightheadedness
  • Changes in your heart rate
  • Difficulty breathing
• An infusion reaction does not always mean you have to stop treatment. More likely, if you have an infusion reaction, we will treat you with medication prior to your next infusion.

Brain Bleeding and / or Swelling - ARIA

A potential side effect of the treatment is brain bleeding and swelling . This is likely due to

the way lecanemab works to remove amyloid from the brain.

• This brain bleeding and swelling is known as Amyloid Related Imaging Abnormalities (ARIA). This is seen on brain imaging and does not always cause symptoms.
• Usually, ARIA is temporary, mild-moderate in severity and resolves on its own over time. However, it can lead to serious symptoms. 
  • ARIA typically occurs in the first 6 months of treatment. However, it can occur at anytime and it can re-occur after resolving.
• In the clinical trials, 21% of patients had ARIA, but only 3% of these patients had symptoms.
• Brain bleeding and swelling is more likely to occur in patients who: 
  • Have two copies of the APOE-e4 gene, 
  • Are taking certain medications like blood thinners
  • Have/had certain changes in their brain seen in imaging. 
• During your evaluation period, you will undergo multiple tests to help us better understand your risk associated with receiving lecanemab.
• Because there is often no symptoms associated with brain bleeding or swelling, routine MRIs at specific time intervals will monitor for these changes.

When symptoms are associated with brain bleeding or swelling, they may include:

• Headache
• Confusion
• Dizziness
• Vision changes
• Nausea
• Difficulty walking / gait changes
• Rare, but more serious symptoms include:
  • Seizure
  • Stroke-like symptoms: speech changes, facial drooping, arm/leg weakness or numbness, severe headache, sudden or severe confusion

What happens if I develop ARIA?