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Lecanemab for Alzheimer’s disease

BMJ 2022; 379 doi: (Published 19 December 2022) Cite this as: BMJ 2022;379:o3010
  1. Sebastian Walsh, doctoral student1,
  2. Richard Merrick, doctoral student1,
  3. Edo Richard, professor of neurology23,
  4. Shirley Nurock, patient/carer representative4,
  5. Carol Brayne, professor of public health medicine1
  1. 1Cambridge Public Health, University of Cambridge, Cambridge, UK
  2. 2Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
  3. 3Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
  4. 4London, UK
  1. Correspondence to: S Walsh sjw261{at}

New trial reports little to celebrate for patients and carers

The detailed results of a phase 3 randomised controlled trial of lecanemab,1 the latest monoclonal antibody drug for Alzheimer’s disease, prompted feverish media coverage heralding a new era of disease modifying treatments. Such treatment has been long hoped for, for differing reasons, by patients, clinicians, researchers, governments, and drug companies. However, the null effects on cognition of other anti-amyloid agents,23 the tiny effect on cognition reported for lecanemab, and concerns about safety4 mean that perspective is needed. Hyperbolic rhetoric gives patients and their families false hope, which clinicians must address, and pre-empts regulatory decision making.

Unlike previous trials of anti-amyloid immunotherapy, the lecanemab trial found a statistically significant result, indicating that the reported difference between placebo and treatment groups in average rate of cognitive decline was unlikely to be due to chance. The prevailing narrative is that this trial “succeeded” where others have “failed.” In reality, lecanemab, like other anti-amyloid agents, successfully cleared amyloid from the brain. This clearance had no discernible effect on cognition …

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