Reacción a "Anti-amyloid drugs for Alzheimer's disease have not been shown to have clinically significant effects, according to a Cochrane review"

The authors concluded that the effects of these therapies on cognitive function and dementia severity were trivial to small, while increasing the risk of adverse events such as brain swelling and bleeding. The findings concord with the decisions of several international governmental agencies to deny approval based on efficacy, including the Australian PBAC, but differ from others, such as the USA.

Cochrane reviews represent the highest standard of evidence-based healthcare. They have included all major trials published to 7 August 2025. However, the inclusion of older trials known to be negative does skew the findings somewhat, as we know that these agents had less amyloid clearance than newer agents. It would have been interesting to have a pooled analysis of the 3 agents with positive trials, aducanumab, lecanemab, and donanemab.

In addition, their sobering conclusions that “Successful removal of amyloid from the brain does not seem to be associated with clinically meaningful effects … future research … should focus on other mechanisms of action” will be contentious. The Alzheimer’s disease field still contains a solid majority of adherents to the amyloid hypothesis, and these comments will spark intense debate. However, there will be many clinicians who welcome this objective guidance for evidence-based care.