From the Research
Premedication for Leqembi (lecanemab) infusions should include antihistamines, antipyretics, and sometimes corticosteroids to reduce the risk of infusion-related reactions, as supported by the most recent study 1. A common regimen includes diphenhydramine 25-50 mg orally and acetaminophen 650 mg orally, both administered 30-60 minutes before the infusion begins. For patients with a history of infusion reactions or those at higher risk, adding a corticosteroid such as methylprednisolone 100 mg IV or an equivalent dose of another corticosteroid may be beneficial. These medications help prevent or minimize potential reactions like headache, confusion, nausea, vomiting, dizziness, or more serious symptoms such as hypertension, hypotension, or angioedema that can occur during the infusion. The premedication protocol may be adjusted based on individual patient factors, including prior reaction history and comorbidities. Some key points to consider when administering lecanemab include:
- Monitoring for amyloid-related imaging abnormalities (ARIA) and infusion reactions, as reported in studies 2, 3, 4, 1
- Adjusting the premedication protocol based on individual patient factors, such as prior reaction history and comorbidities
- Considering the use of corticosteroids for patients at higher risk of infusion reactions
- Closely monitoring patients during and after the infusion for potential reactions. It is essential to note that lecanemab has been associated with an increased risk of ARIA-E and ARIA-H, particularly in ApoE4 carriers, as highlighted in the most recent systematic review and meta-analysis 1. Therefore, careful consideration and monitoring are necessary when administering lecanemab to these patients. Overall, the premedication regimen for Leqembi infusions should be tailored to the individual patient's needs and risk factors, with a focus on minimizing the risk of infusion-related reactions and monitoring for potential adverse events.