Characteristics of infusion-related reactions to lecanemab in early Alzheimer’s disease: a multicenter real-world study in Northwestern China - 10/03/26

Doi : 10.1016/j.tjpad.2026.100542

Peijie Liu ^1,^{⁎
Peijie Liu and Jie Liu contributed equally and are joint first authors.}, Jie Liu ^1,^{⁎
Peijie Liu and Jie Liu contributed equally and are joint first authors.}, Jin Wang ¹, Ying Du ², Zhirong Liu ³, Hong Zhang ⁴, Aiqin Zhu ⁵, Gejuan Zhang ⁶, Xinling Meng ⁷, Chunmei Zhao ⁸, Weiping Zhang ⁹, Liangjun Dang ¹, Wei Zhang ^2,^⁎ , Qiumin Qu ^1,^⁎ , Yan Qu ^1,^⁎

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

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

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

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

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

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

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

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

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

⁺ Correspondence: Yan Qu, Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an, 710061, China. Department of Neurology The First Affiliated Hospital of Xi’an Jiaotong University No. 277 West Yanta Road Xi’an 710061 China ⁺⁺ Correspondence: Qiumin Qu, Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Xi’an, 710061, China. Department of Neurology The First Affiliated Hospital of Xi’an Jiaotong University No. 277 West Yanta Road Xi’an 710061 China ⁺⁺⁺ Correspondence: Wei Zhang, Department of Neurology, Tangdu Hospital, Air Force Medical University, No. 169, Changle West Road, Xi’an, 710032, China Department of Neurology Tangdu Hospital Air Force Medical University No. 169, Changle West Road Xi’an 710032 China

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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.

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Abstract

BACKGROUND

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

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.

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