Characteristics of infusion-related reactions to lecanemab in early Alzheimer’s disease: a multicenter real-world study in Northwestern China

 

Peijie Liu^1*, Jie Liu^1*, Ying Du², Zhirong Liu³, Hong Zhang⁴, Aiqin Zhu⁵, Gejuan Zhang⁶, Xinling Meng⁷, Chunmei Zhao⁸, Weiping Zhang⁹, Liangjun Dang¹, Wei Zhang²⁺, Jin Wang¹⁺, Qiumin Qu¹⁺, Yan Qu¹⁺

 

¹Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

²Department of Neurology, Tangdu Hospital, Air Force Medical University, Xi’an, China

³Department of Neurology, Xijing Hospital, Air Force Medical University, Xi’an, China

⁴Department of Neurology, Shaanxi Provincial People’s Hospital, Xi’an, China

⁵Department of Geriatrics, Qinghai Provincial People’s Hospital, Xining, China

⁶Department of Neurology, The Affiliated Hospital of Northwest University, Xi’an No.3 Hospital, Xi’an, China

⁷Encephalopathy Department I, The Fourth Affiliated Hospital of Xinjiang Medical University (Xinjiang Hospital of Traditional Chinese Medicine), Urumqi, China

⁸Department of Neurology, General Hospital of Ningxia Medical University, Yinchuan, China.

⁹Department of Neurology, Xi’an Central Hospital, Xi’an, China

 

 

Abstract

INTRODUCTION

Lecanemab is the first drug approved by the FDA for the treatment of early Alzheimer’s disease (AD). Infusion-related reactions (IRRs) represent the most common adverse events associated with Lecanemab. However, real-world data on IRR characteristics and risk factors in Asian populations, particularly Chinese, remain scarce.

 

METHODS

In a multicenter prospective registry, 139 patients with early Alzheimer’s disease (AD) receiving lecanemab were included. IRRs were physician-confirmed. Multivariable logistic regression identified independent predictors.

 

RESULTS

A total of 139 patients from 13 hospitals in Northwestern China received lecanemab therapy between July 2024 and September 2025. The cumulative IRR incidence was 12.36%, highest at the first infusion (17.3%) and decreased significantly thereafter (P < 0.001). Fever (54.2%) and dizziness (16.7%) were the most common symptoms. 45.8% of IRRs occurred 2-24 hours after infusion. All IRRs were mild (Grade 1) and self-limited. Hypertension (OR = 5.017, P = 0.007) and higher Fazekas score (OR = 2.734, P = 0.017) were independently associated with IRR.

 

DISCUSSION

In this Chinese real‑world cohort, lecanemab‑associated IRRs were less frequent, mild, and delayed. Hypertension and white‑matter hyperintensity severity emerged as key risk factors, underscoring the potential role of cerebrovascular health in IRR susceptibility.

 

HIGHLIGHTS

•Lower incidence, mild severity, and delayed onset characterize lecanemab‑associated IRRs in the Northwestern Chinese cohort.

•The IRR incidence was highest at the first lecanemab infusion and decreased significantly thereafter.

•Hypertension and white matter hyperintensity burden (higher Fazekas scores) are independent risk factors of IRRs.

 

KEYWORDS

Alzheimer’s disease, lecanemab, infusion-related reaction, risk factors, real-world study