ex differences in the effects of Lecanemab in early Alzheimer’s disease: a multicenter real-world study in Northwestern China

Liu Peijie, Cui Simeng, Liu jie, Dang Liangjun, Qu Qiumin and Wang Jin^*

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

^* Corresponding author at: Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Rd, Xi’an 710061, China. Tel./Fax: +86-29 8532 4083. E-mail address: drwangjin@xjtufh.edu.cn.

Background

Lecanemab is the first drug approved by the FDA for the Aβ clearance in Alzheimer’s disease (AD) therapy. Subgroup analysis of Clarity AD indicated limited effectiveness in females. However, real-world data on sex differences in the treatment of Lecanemab in Chinese populations had not been reported.

Methods

This is a multicenter case registry study conducted at 13 hospitals in Northwest China. All patients who were confirmed Aβ-positive by CSF or PET scan, treated with Lecanemab, were enrolled. The efficacy of Lecanemab was evaluated using CDR-SB, ADAS-cog, ADCS-ADL, and MMSE every 3 months.

Results

There were 189 participants who received Lecanemab treatment until January 10, 2026, of whom 123 (65.1%) were females. The clinical characteristics had no significant differences between females and males at baseline. The mean change from baseline at 12 months in the CDR-SB score was 0.81 in the female group and 0.50 in the male group (difference, 0.31; 95%CI, -1.54 to 2.17; P=0.715), in the MMSE score was -0.56 in the females and 0.50 in the males (difference, -1.06; 95%CI, -5.48 to 3.37; P=0.574), in the ADAS-cog score was 0.11 in the females and -1.50 in the males (difference,1.61; 95%CI, -6.53 to 9.76; P=0.660), while in the ADCS-ADL score was -6.29 in the female group and 1.33 in the male group (difference, −7.62; 95%CI, −13.52 to −1.72; P=0.022).

Conclusion

During 12 months of treatment with lecanemab, the cognitive outcomes showed no significant difference between females and males; however, females showed a greater decline in functional ability. These suggest that the sex difference in the effects of lecanemab needs to be further confirmed.

Keywords: Alzheimer’s disease; Aβ clearance; Lecanemab; sex difference