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Real-World Characterization of Amyloid-Related Imaging Abnormalities (ARIA) in Lecanemab Treatment at an Academic Health System
Rezaii N, Dickson JR, Ford JN, He Y, Katsumi Y, Ramirez-Gomez L, Lam A, Shah H et al.. medRxiv, 2026-01-25
Topic: Plasma and spinal-fluid biomarkers
Background The benefits of amyloid-β monoclonal antibodies for Alzheimer’s disease are tempered by the risk of amyloid-related imaging abnormalities (ARIA). Detailed real-world characterization of ARIA, including incidence, timing, radiologic severity and localization, natural history, and risk factors, is essential to optimize treatment safety. This study provides a comprehensive description of ARIA in a large real-world cohort of patients receiving lecanemab. Methods In this retrospective cohort study from the Mass General Brigham Alzheimer’s Therapeutic Program, we analyzed data from 468 patients with early Alzheimer’s disease who were at least 90 days from their first lecanemab infusion, including those whose treatment was modified or discontinued. ARIA was monitored using a standardized MRI protocol. High-dimensional analysis of baseline clinical, laboratory, and biomarker variables was performed using univariate correlations and Cox proportional hazards models with data-driven cutpoints. Findings The overall incidence of any ARIA was 25.2%, with ARIA-H occurring in 22.4% of patients and ARIA-E in 12.2%. Symptoms developed in 4.5% of all patients. Both subtypes demonstrated significant occipital involvement, with ARIA-H showing additional frontotemporal predominance. ARIA-H was typically mild and persistent with rare radiologic resolution, whereas ARIA-E was transient, resolving with a mean time to resolution of 75.6 days. Key baseline predictors of ARIA-H included CSF Aβ42 ≤683.8 pg/mL (HR 6.39), ≥1 microhemorrhage (HR 2.55), and at least one APOE ε4 allele (HR 1.77). ARIA-E was predicted by diastolic blood pressure >75 mmHg (HR 3.12), serum chloride >105 mmol/L (HR 2.79), at least one APOE ε4 allele (HR 2.51), and serum sodium >141 mmol/L (HR 1.70). ARIA-Mixed was associated with elevated serum chloride >105 mmol/L (HR 3.92), at least one APOE ε4 allele (HR 2.87), and diastolic blood pressure >75 mmHg (HR 2.60). Interpretation This comprehensive real-world characterization of ARIA, together with the identification of novel modifiable risk factors for ARIA-E, including elevated diastolic blood pressure and high-normal serum electrolytes, enables personalized risk assessment and tailored monitoring, thereby advancing the safe implementation of disease-modifying Alzheimer’s therapies. Funding Funding for this project was provided by the Mass General Neuroscience Transformative Scholar Award.
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APA 7th
Rezaii, N., Dickson, JR., Ford, J. N., He, Y., Katsumi, Y., Ramirez-Gomez, L., et al. (2026). Real-World Characterization of Amyloid-Related Imaging Abnormalities (ARIA) in Lecanemab Treatment at an Academic Health System. medRxiv. https://doi.org/10.64898/2026.01.23.26344739
Vancouver
Rezaii N, Dickson JR, Ford JN, He Y, Katsumi Y, Ramirez-Gomez L, et al. Real-World Characterization of Amyloid-Related Imaging Abnormalities (ARIA) in Lecanemab Treatment at an Academic Health System. medRxiv. 2026. doi:10.64898/2026.01.23.26344739.
BibTeX
@article{rezaii2026-4202aa20,
author = {Rezaii, N. and Dickson, JR. and Ford, J. N. and He, Y. and Katsumi, Y. and Ramirez-Gomez, L. and Lam, A. and Shah, H. and others},
title = {{Real-World Characterization of Amyloid-Related Imaging Abnormalities (ARIA) in Lecanemab Treatment at an Academic Health System}},
journal = {medRxiv},
year = {2026},
doi = {10.64898/2026.01.23.26344739},
url = {https://doi.org/10.64898/2026.01.23.26344739}
}
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Key findings
- Findings The overall incidence of any ARIA was 25.2%, with ARIA-H occurring in 22.4% of patients and ARIA-E in 12.2%.
- Both subtypes demonstrated significant occipital involvement, with ARIA-H showing additional frontotemporal predominance.
- ARIA-Mixed was associated with elevated serum chloride >105 mmol/L (HR 3.92), at least one APOE ε4 allele (HR 2.87), and diastolic blood pressure >75 mmHg (HR 2.60).
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Study details
- Study designcohort study
- Participants468
- Effect size25.2%; 22.4%; 12.2%
- Evidence strengthModerate
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 47 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for randomised / blinded because the record does not state it. We have no data on 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 29 of the 62 points we could judge it on, which is 47 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (medRxiv) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 2 / 4 | 468 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| 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 | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 29 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 29 of the 62 points we could judge it on is 47 out of 100. |
| Total | 47 / 100 | Capped to 16 because this is not a peer-reviewed article. |
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