Real-world safety and implementation challenges of lecanemab therapy for Alzheimer's disease in South Korea: a single-center experience

Topic: Amyloid, tau and blood-test diagnosis

Lecanemab, an amyloid-targeting monoclonal antibody, was recently approved for early symptomatic Alzheimer's disease in South Korea. Asians were underrepresented in prior trials, and real-world data from Korea remain scarce, particularly regarding treatment settings, adverse events, and barriers to scalability. We assessed the feasibility and safety of lecanemab among Korean patients in a real-world tertiary hospital. A total of 112 patients initiated lecanemab treatment between December 2024 and October 2025 at Asan Medical Center. Prevalence of infusion-related reactions (IRRs), Amyloid-Related Imaging Abnormalities (ARIA), treatment discontinuation, and factors limiting implementation were evaluated. Among 112 patients (mean age 71 years; 59% female), IRRs occurred in 41 (37%) and were generally mild or moderate under active surveillance. Among 105 at-risk patients who received at least four infusions and had at least one monitoring MRI, ARIA developed in 20 (19%): ARIA-E/H in 6 (5.7%) and isolated ARIA-H in 14 (13.3%). Only 1 patient with isolated ARIA-H presented with transient confusion. Patients with ARIA-E/H were younger, whereas those with ARIA-H were older and more likely to have baseline microhemorrhages. Eleven out of 105 were APOE ε4/ε4 homozygotes, of whom 5 developed ARIA. The rapid increase in treatment demand exceeded outpatient infusion capacity, resulting in progressively longer waiting times-up to 20 weeks 9 months after program initiation. This single-center experience from a tertiary referral hospital in Korea demonstrates that lecanemab treatment was feasible and generally well-tolerated, with manageable adverse events including ARIA and IRRs; however, limited infusion capacity, lack of reimbursement, and patient concentration in tertiary centers highlight the need for referral networks and system-level strategies to improve nationwide accessibility.

@article{hyemin2026-42449395,
  author  = {Hyemin, Jang and Woo, Kim Jae and Won, Hwang Jung and Da Woon, Jeong and Jeongeun, Ka and Da Min, Kang and Hyun, Suh Chong and Yangsean, Choi and others},
  title   = {{Real-world safety and implementation challenges of lecanemab therapy for Alzheimer's disease in South Korea: a single-center experience}},
  journal = {Alzheimer's research \& therapy},
  year    = {2026},
  doi     = {10.1186/s13195-026-02141-1},
  pmid    = {42449395},
  url     = {https://doi.org/10.1186/s13195-026-02141-1}
}

Key findings

• Only 1 patient with isolated ARIA-H presented with transient confusion.
• Patients with ARIA-E/H were younger, whereas those with ARIA-H were older and more likely to have baseline microhemorrhages.
• Eleven out of 105 were APOE ε4/ε4 homozygotes, of whom 5 developed ARIA.
• The rapid increase in treatment demand exceeded outpatient infusion capacity, resulting in progressively longer waiting times-up to 20 weeks 9 months after program initiation.
• This single-center experience from a tertiary referral hospital in Korea demonstrates that lecanemab treatment was feasible and generally well-tolerated, with manageable adverse events including ARIA and IRRs; however, limited infusion capacity, lack of reimbursement, and patient concentration in tertiary centers highlight the need for referral networks and system-level strategies to improve nationwide accessibility.

Why it matters

In 112 Korean patients treated with lecanemab at one hospital, infusion-related reactions occurred in 37% and ARIA in 19% of those monitored, and demand outstripped infusion capacity with waits up to 20 weeks. This single-centre real-world experience describes safety and implementation challenges of an approved therapy, not a cure or prevention.

Study details

• Participants112
• Effect size5.7%; 13.3%
• Evidence strengthLow

Read the original

• DOI: 10.1186/s13195-026-02141-1
• PubMed: 42449395
• Original source →
• Free full text: Alzheimer s Research & Therapy →

Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).

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