Amyloid-related imaging abnormalities in a woman with apolipoprotein E ε4 homozygotes treated with lecanemab for Alzheimer's disease

Q4 Immunology and Microbiology

Clinical and Experimental Neuroimmunology Pub Date : 2024-12-09 DOI:10.1111/cen3.12821

Moeko Noguchi-Shinohara, Junji Komatsu, Kenjiro Ono

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Abstract

Background

Lecanemab (Leqembi®) is an anti-amyloid monoclonal antibody used for the treatment of Alzheimer's disease (AD). However, side effects may occur with lecanemab, including amyloid-related imaging abnormalities (ARIA), especially in patients with apolipoprotein E ε4 (APOE4) homozygous.

Case Presentation

A 69-year-old woman had a 2-year history of worsening memory symptoms and was diagnosed with mild cognitive impairment due to AD. Because she carries two copies of the E4 allele of APOE, her doctor did not recommend lecanemab treatment. However, she strongly desired lecanemab treatment and received four infusions of lecanemab. She had no symptoms or neurological abnormalities, but a head MRI before the fifth infusion showed moderate radiographic ARIA; therefore, she was admitted and treated with steroids. One month later, a head MRI showed the ARIA had disappeared.

Conclusion

The indications of lecanemab treatment for patients with APOE4 homozygous must be carefully considered due to the higher risk of ARIA.

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用lecanemab治疗阿尔茨海默病的载脂蛋白E ε4纯合子女性的淀粉样蛋白相关影像学异常

leanemab （Leqembi®）是一种用于治疗阿尔茨海默病（AD）的抗淀粉样蛋白单克隆抗体。然而，lecanemab可能会出现副作用，包括淀粉样蛋白相关成像异常（ARIA），特别是载脂蛋白E ε4 （APOE4）纯合子患者。病例介绍一名69岁女性，有2年的记忆症状恶化史，被诊断为AD引起的轻度认知障碍。因为她携带了两个APOE的E4等位基因，她的医生不建议她使用莱卡耐单抗治疗。然而，她强烈希望接受莱卡耐单抗治疗，并接受了四次莱卡耐单抗输注。她没有症状或神经系统异常，但在第五次输注前的头部MRI显示中度放射学ARIA；因此，她入院并接受类固醇治疗。一个月后，头部核磁共振显示ARIA消失了。结论APOE4纯合子患者发生ARIA的风险较高，应慎重选择莱卡耐单抗治疗的适应症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical and Experimental Neuroimmunology Immunology and Microbiology-Immunology and Microbiology (miscellaneous)

CiteScore

1.60

自引率

0.00%

发文量