Gantenerumab didn’t improve cognitive decline in two trials that followed 2,000 people for over 2 years. Patients treated with gantenerumab had a slowing of clinical decline in the GRADUATE and GRADUATE II trials of –0.31, and –0.19, respectively, from baseline on the CDR-SB scale, representing a relative reduction of 8% and 6%, respectively, compared with placebo. The level of amyloid-β removal was lower than anticipated.

In contrast, Biogen/Eisai announced September 28 that lecanemab met its primary endpoint, reducing clinical cognitive decline on CDR-SB scale by 27% compared with placebo, representing a score change of –0.45. Nevertheless, many questions remain about this drug, including whether the reduction in cognitive decline is meaningful for patients and caregivers, as well as why lecanemab succeeded when other Aβ antibodies failed.

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