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Lecanemab in Singapore: Appropriate use recommendations for early Alzheimer's disease
Chen CL, Kandiah N, Kumar S, Lee KE, Liew TM, Ng ASL, Ng KP, Tay LBG et al.. Annals of the Academy of Medicine, Singapore, 2026-11-04
Topic: Amyloid, tau and blood-test diagnosis
Introduction Lecanemab, a monoclonal antibody targeting β-amyloid oligomers, protofibrils, and insoluble fibrils, has been approved for Alzheimer's disease (AD) treatment in Singapore, based on the phase 3 Clarity AD study. In this paper, the Singapore-adapted Appropriate Use Recommendations (AURs) serve to assist Singapore physicians in identifying patients who will likely benefit from treatment while ensuring effective monitoring. Method The AURs are based on the Singaporeapproved prescribing information combined with lecanemab phase 2 and 3 clinical trials and real-world data up to April 2026. Results The decision to initiate lecanemab should be based on careful evaluation of individuals, including Singapore-validated cognitive status tests to identify mild cognitive impairment (MCI) due to AD and mild AD dementia. Other important evaluations include baseline brain magnetic resonance imaging (MRI), assessment of the apolipoprotein E ε4 (APOEε4) genotype, and amyloid pathology confirmation. Guidance on identifying patients at increased risk of amyloid-related imaging abnormalities (ARIA) during treatment and other patient profiles warranting additional caution is provided. Recommendations for monitoring patients, managing infusion-related reactions, and identifying lecanemab discontinuation scenarios are included. Conclusion Lecanemab should only be prescribed for patients with MCI due to AD or mild AD dementia following careful clinical evaluation confirming AD pathology, with caution exercised in patients at increased ARIA risk (e.g. APOEε4 gene carriers). During treatment, patients should receive regular monitoring for ARIA symptoms including follow-up MRI scans. Future directions include the development of a Singapore-specific registry to monitor patients and gather long-term data to support a consensus-driven framework to inform and optimise the use of lecanemab in Singapore.
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APA 7th
Chen, C. L., Kandiah, N., Kumar, S., Lee, K. E., Liew, T. M., Ng, A. S. L., et al. (2026). Lecanemab in Singapore: Appropriate use recommendations for early Alzheimer's disease. Annals of the Academy of Medicine, Singapore. https://doi.org/10.47102/annals-acadmedsg.2026185
Vancouver
Chen CL, Kandiah N, Kumar S, Lee KE, Liew TM, Ng ASL, et al. Lecanemab in Singapore: Appropriate use recommendations for early Alzheimer's disease. Annals of the Academy of Medicine, Singapore. 2026. doi:10.47102/annals-acadmedsg.2026185. PMID: 42995156.
BibTeX
@article{chen2026-42995156,
author = {Chen, C. L. and Kandiah, N. and Kumar, S. and Lee, K. E. and Liew, T. M. and Ng, A. S. L. and Ng, K. P. and Tay, L. B. G. and others},
title = {{Lecanemab in Singapore: Appropriate use recommendations for early Alzheimer's disease}},
journal = {Annals of the Academy of Medicine, Singapore},
year = {2026},
doi = {10.47102/annals-acadmedsg.2026185},
pmid = {42995156},
url = {https://doi.org/10.47102/annals-acadmedsg.2026185}
}
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Key findings
- Results The decision to initiate lecanemab should be based on careful evaluation of individuals, including Singapore-validated cognitive status tests to identify mild cognitive impairment (MCI) due to AD and mild AD dementia.
- Guidance on identifying patients at increased risk of amyloid-related imaging abnormalities (ARIA) during treatment and other patient profiles warranting additional caution is provided.
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Study details
- Study designclinical trial
- Evidence strengthLow
How this study scored 43/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 25 of the 58 points we could judge it on, which is 43 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Annals of the Academy of Medicine, Singapore) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 0 / 12 | Design recorded as “clinical trial”, which our rubric does not rank (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 42995156) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 25 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 25 of the 58 points we could judge it on is 43 out of 100. |
| Total | 43 / 100 | — |
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