👤 Nicola Vanacore

Mild cognitive impairment (MCI) is an intermediate stage between normal and pathological brain aging, with 30% to 50% progressing to dementia within 3 to 5 years. Early identification of individuals at high risk of progression is crucial for public health strategies. The INTERCEPTOR project included 398 MCI individuals. Baseline assessment included harmonized procedures for sociodemographic, clinical, neuropsychological, genetic (apolipoprotein E), cerebrospinal fluid (amyloid beta tau), electroencephalogram (brain connectivity), magnetic resonance imaging (hippocampal volumetry), and fluorodeoxyglucose positron emission tomography. The baseline and follow-up were completed by 351 individuals with MCI with neuropsychological tests every 6 months for 3 years. Dementia developed in 104 individuals (29.6%), including 85 (22.4%) who met core clinical criteria for probable and possible Alzheimer's disease dementia. A Cox model combining clinical and sociodemographic data achieved a concordance index of 72%, which increased to 82% when neuropsychology and biomarkers were added. The INTERCEPTOR nomogram represents a tool for predicting dementia progression risk, supporting public health strategies, including screening for risk assessment and risk/benefit ratio in innovative treatments. Show less

In recent years, lecanemab received regulatory approval from several regulatory agencies. The safety profile, particularly the risk of amyloid-related imaging abnormalities (ARIA), necessitates post-marketing surveillance. From a public health perspective, generating robust real-world evidence (RWE) is essential. This study aims to inform policy and clinical decision-makers by analyzing prescribing information, literature evidence, and the FDA Adverse Events Reporting System (FAERS) pharmacovigilance reports. This study employed a mixed-method approach. First, prescribing information for lecanemab was collected and compared across four regulatory agencies. Second, a systematic literature review was conducted in MEDLINE and Embase to identify RWE studies reporting adverse events (AEs), symptoms, or management strategies in patients treated with lecanemab. Finally, post-marketing safety data from the FAERS database were analyzed. Four regulatory agencies have approved lecanemab through different pathways, each requiring confirmation of amyloid pathology and careful assessment of ARIA risk, particularly in Apolipoprotein E (ApoE) ε4 homozygotes. Notable differences exist across agencies regarding indications, contraindications, monitoring protocols, and criteria for treatment suspension, resumption, or discontinuation. All authorities mandate post-marketing programs to ensure ongoing monitoring of safety and effectiveness. A bibliographic search identified 26 studies. Nine cohort studies included between 19 and 407 participants and reported follow-up periods ranging from 6 to 14 months; in a few studies, lecanemab was administered to individuals with moderate or severe AD. As expected, infusion-related reactions (IRRs) and ARIA were the most frequent adverse events, predominantly occurring within the first seven infusions. Some studies reported preliminary efficacy outcomes, although attrition bias may have affected these findings. Seventeen case reports described nineteen individuals aged 57–82, with most AEs arising between the 3rd and 7th infusion and primarily consisting of ARIA; serious events such as stroke, seizures, and two fatalities were also noted. In most cases, lecanemab was paused or permanently discontinued. Analysis of the FAERS database identified 1,286 reports revealing 2,627 AEs, of which 30% were classified as serious, including forty-six deaths. The most reported AEs were headache, ARIA-E, ARIA-H, and chills. ARIA-E and ARIA-H have similar demographics, onset timing, and severity profiles. This study highlights the complexity of lecanemab’s safety profile and the variability in regulatory prescribing recommendations. While ARIA, especially in ApoE ε4 homozygotes, remains the most frequent adverse event, its severity ranges from mild to, in rare cases, severe or fatal. These findings underscore the need for robust post-marketing surveillance and harmonized recommendations to ensure safe and effective clinical use. The online version contains supplementary material available at 10.1007/s10072-026-08829-4. Show less