A meta-analysis of 37 real-world reports on lecanemab found amyloid-related imaging abnormalities (ARIA) in 15.1% of cases, with higher rates among APOE ε4 homozygotes and those with baseline microhemorrhages. The analysis also concluded that controlled evidence remains insufficient to confirm cognitive benefit. The findings are likely to influence how clinicians weigh imaging surveillance and risk stratification in real-world treatment decisions, especially outside trial settings where selection criteria may differ. In practical terms, the signal reinforces the need for standardized monitoring protocols when prescribing anti-amyloid antibodies. For biotech and clinical leaders, the work highlights how post-approval evidence is increasingly shaping treatment risk discussions, particularly for neurologic immunotherapies.