Lecanemab Therapy Contraindications

Exclusionary Criteria

The American College of Radiology recommends patient screening with MRI within 12 months of initiation to detect certain exclusionary criteria that might increase the risk of Amyloid-Related Imaging Abnormalities (ARIA) and their related complications 1
Multiple lacunar infarcts are specifically listed among the imaging findings that would exclude patients from therapy with anti-amyloid monoclonal antibodies 1
Other exclusionary findings include intraparenchymal macrohemorrhages >10 mm in diameter, 4 or more microhemorrhages <10 mm in diameter, evidence of superficial siderosis, evidence of vasogenic edema, significant white matter hyperintensities, and any infarcts involving a major vascular territory 1

ARIA is the predominant neurologic complication associated with anti-amyloid monoclonal antibody therapy, presenting in two forms: ARIA-E (edema and/or effusion) and ARIA-H (hemorrhage) 1
In the CLARITY AD phase 3 trial, ARIA-E was detected in up to 12.6% of patients receiving Lecanemab 1
ARIA-H has an incidence ranging from 15% to 20% in clinical trials 1

The presence of multiple lacunar infarcts of Fazekas 2 is a direct contraindication to Lecanemab therapy, and the presence of early left MCA arteropathy raises additional concerns about cerebrovascular risk 1, 2
Generalized atrophy may represent advanced neurodegeneration that could limit therapeutic benefit 2