The AD/PD 2025 conference, held April 1–5 in Vienna, Austria, brought together global experts to share the latest advances in treatment, early diagnosis, and clinical research in Alzheimer’s, Parkinson’s Disease and related neurological disorders. With a packed agenda of Forum Discussions, Symposia and scientific presentations, the meeting continued its tradition of spotlighting cutting-edge developments in neurodegenerative disease.
In this Q&A, Dr Andy Liu, Associate Professor of Neurology at Duke University School of Medicine, discusses his presentation on the clinical use of lecanemab in Alzheimer’s disease. Drawing on real-world experience and findings from the 2022 CLARITY AD study, Dr Liu explores the treatment’s benefits, challenges in daily practice and the importance of patient-centred care in this evolving therapeutic landscape.
1. What do we already know about lecanemab from previous research, and what was the aim of this study?
There was a landmark study in 2022 called the CLARITY AD study, which evaluated cognitive function using a quantitative tool called the Clinical Dementia Rating–Sum of Boxes (CDR-SB). This scale assesses six categories of cognitive and functional performance, with each category scored up to three points—the higher the total score, the more impaired the individual.
The study found that people receiving lecanemab performed slightly better on the CDR-SB compared to those on placebo. What I emphasize in clinic, however, is that while the results were statistically significant, that does not necessarily translate to clinical significance. It’s important to be clear that this medication does not reverse or restore function. The amyloid proteins involved are toxic and have been damaging brain cells for decades—and unfortunately, we don’t yet have the means to replace those lost cells.
2. What insights did the study provide about the safety of lecanemab, particularly regarding ARIA and mortality?
Based on the study, we generally talk about two broad categories of side effects in the clinic. The most commonly seen are infusion reactions—things like headaches, dizziness, imbalance, and vision changes. These occurred in about a quarter of patients in the clinical trial, and that aligns with our experience as well. Especially after the first one or two infusions, some patients may have a bad headache or feel a bit dizzy—those are the most frequent issues we observe.
The more serious concern is amyloid-related imaging abnormalities (ARIA), which people often fear most. However, ARIA seems to be less common in our experience and occurs at a rate similar to what was reported in the study. There are different types of ARIA, but we manage them quite well because we’re aware of the risks and monitor patients closely with MRI.
In terms of mortality, there have been a few deaths, similar to what was seen in the trial. While lecanemab may be directly related in some cases, most of the time the cause is a comorbid condition—such as a pulmonary embolism unrelated to the drug—where the patient just happened to be on lecanemab. Initially, I was hesitant about the safety profile, but overall, I’ve found it to be consistent with the clinical trial data.
3. How might the observed changes in cognitive assessments impact how lecanemab is viewed in real-world clinical practice?
What I often emphasize is the distinction between statistical significance and clinical significance. That’s how I interpret the data, and what I tell patients is that they likely won’t notice any significant changes in how they feel. Essentially, where they are now is where they can expect to stay as they continue with the infusions.
The goal is not just to slow or delay the progression of the disease, but to help patients remain well enough to participate in meaningful life events, like a grandchild’s graduation or a 60th wedding anniversary. I also remind them that this is just the beginning of a new era in Alzheimer’s treatment. By delaying disease progression now, we’re helping prepare them for the next generation of therapies that are already in the pipeline.
4. What does this early real-world experience suggest about how clinicians should approach patient selection and monitoring when prescribing lecanemab?
There’s a lot of literature outlining appropriate use recommendations for lecanemab – when it should and shouldn’t be used. But for me, it ultimately comes down to patient autonomy. That’s my personal approach. While some clinicians prefer to take a more cautious, firm stance, I believe in having open discussions with patients when there are concerns.
For instance, I had a patient with a very small infarct visible on an MRI from the past year. According to the guidelines, that would exclude them from starting lecanemab. But I believe in having a discussion and prioritising patient autonomy. I share the recommendations advise against it, but based on their specific case I think there’s a good chance they won’t experience adverse effects from it. This person has been doing well on lecanemab.
Many patients are eager to try lecanemab, or at least want to feel like they’re doing something, and that’s where I come from too. I practiced behavioural neurology for years without disease-modifying treatments, and I know where the story ends. So, even if it means they might experience infusion reactions or ARIA, I want to give patients that fighting chance.
Of course, lecanemab comes with practical burdens, it requires infusions twice a month, and many patients want to enjoy time with family and have travel plans to see the world. I completely understand why some might opt out. But in most cases, patients want to do what they can to slow the disease, and my role is to help them make informed choices about that opportunity.
Disclosures:
Citation: Experiences of lecanemab in a clinical setting: An interview with Dr Andy Liu #ADPD2025. touchNEUROLOGY.com. 30 April 2025.
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