Lisa B E Shields, Hannah S Hust, Gregory E Cooper, Theresa Kluthe, Rachel N Hart, Andrew P Thaliath, Brandon C Dennis, Stephanie W Freeman, Jessica F Cain, Whoy Y Shang, Kendall M Wasz, Adam T Orr, Christopher B Shields, Shirish S Barve, Kenneth G Pugh
Of the 48 patients who underwent at least one surveillance brain MRI after starting donanemab, 10 (20.8%) had ARIA detected. ε4 carriers more frequently displayed amyloid-related imaging abnormalities (ARIA-cortical superficial hemosiderosis/microhemorrhages [ARIA-H] and/or ARIA-edema/effusion) (p = 0.033) and ARIA-H (p = 0.020) compared to ε4 non-carriers. No patients developed symptomatic ARIA. Seven (13.7%) patients experienced infusion-related side effects. Eight (15.7%) patients discontinued donanemab due to ARIA progression (5), severe infusion reactions (2), and need for anticoagulants (1).
INTRODUCTION: The anti-amyloid monoclonal antibody donanemab (Kisunla™) treats patients with mild cognitive impairment or mild Alzheimer's disease.
METHODS: This study highlights 51 patients who received at least one donanemab infusion at our memory center between October 4, 2024 and October 3, 2025.
RESULTS: Of the 48 patients who underwent at least one surveillance brain MRI after starting donanemab, 10 (20.8%) had ARIA detected. ε4 carriers more frequently displayed amyloid-related imaging abnormalities (ARIA-cortical superficial hemosiderosis/microhemorrhages [ARIA-H] and/or ARIA-edema/effusion) (p = 0.033) and ARIA-H (p = 0.020) compared to ε4 non-carriers. No patients developed symptomatic ARIA. Seven (13.7%) patients experienced infusion-related side effects. Eight (15.7%) patients discontinued donanemab due to ARIA progression (5), severe infusion reactions (2), and need for anticoagulants (1).
DISCUSSION: Donanemab may be safely used in a real-world setting with structured monitoring. ARIA was observed in 20.8% of patients in this implementation cohort. Larger-scale multicenter data are needed to benchmark rates.