Lecanemab Treatment Guidelines for Alzheimer's Disease

Monitoring and Patient Selection

Mandatory MRI monitoring must be performed before the 5th, 7th, and 14th infusions to detect ARIA, according to Praxis Medical Insights 1, 2
Baseline brain MRI is required before treatment initiation to assess for contraindications, as recommended by Praxis Medical Insights 1, 2
Biomarker confirmation requires either amyloid PET, CSF testing, or blood-based biomarkers meeting appropriate performance standards, as stated by Nature Reviews Neurology 3, 4
Patients must have objective cognitive impairment documented by comprehensive neuropsychological testing, according to Praxis Medical Insights 1, 2

Lecanemab is inappropriate for cognitively unimpaired individuals, even with positive biomarkers, as noted by Praxis Medical Insights 2
Treatment requires multidisciplinary teams with specialized training in ARIA management, as recommended by Praxis Medical Insights 1, 2
Hub-and-spoke care models are being developed to address specialist shortages and enable broader access to lecanemab therapy, according to Praxis Medical Insights 1
Blood-based biomarkers, such as plasma p-tau217, are emerging as more accessible screening tools with AUCs of 0.92-0.98 for predicting amyloid status, as reported by Nature Reviews Neurology 4
Enrollment in CMS registry is required for Medicare reimbursement, as noted by Praxis Medical Insights 2

Initiation of lecanemab therapy requires a multidisciplinary care team with specialized training in ARIA management, and patients must be enrolled in a CMS‑approved registry to qualify for Medicare reimbursement. 5

Hub‑and‑spoke care models are being developed to mitigate specialist shortages and expand patient access to lecanemab treatment. 5

Prior to starting therapy, comprehensive counseling covering anticipated benefits, potential risks, and the required monitoring schedule is essential for informed patient consent. 5