Cited by 252Alzheimer's disease research and treatmentsDementia and Cognitive Impairment ResearchCholinesterase and Neurodegenerative Diseases

The DOI matches its Crossref record; 85 of the 86 references it cites were found in a registry or an index; none of the 50 sources its claims cite is checked for support yet.

Clinical trials of new drugs for Alzheimer disease: a 2020–2023 update

Open access
Huang, Li-Kai, Kuan, Yi-Chun, Lin, Ho-Wei, Hu, Chaur-Jong·2023·Journal of Biomedical Science

Abstract

Alzheimer's disease (AD) is the leading cause of dementia, presenting a significant unmet medical need worldwide. The pathogenesis of AD involves various pathophysiological events, including the accumulation of amyloid and tau, neuro-inflammation, and neuronal injury. Clinical trials focusing on new drugs for AD were documented in 2020, but subsequent developments have emerged since then. Notably, the US-FDA has approved Aducanumab and Lecanemab, both antibodies targeting amyloid, marking the end of a nearly two-decade period without new AD drugs. In this comprehensive report, we review all trials listed in clinicaltrials.gov, elucidating their underlying mechanisms and study designs. Ongoing clinical trials are investigating numerous promising new drugs for AD. The main trends in these trials involve pathophysiology-based, disease-modifying therapies and the recruitment of participants in earlier stages of the disease. These trends underscore the significance of conducting fundamental research on pathophysiology, prevention, and intervention prior to the occurrence of brain damage caused by AD.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This 2020–2023 update reviews Alzheimer disease drug trials listed on ClinicalTrials.gov and highlights the FDA approvals of aducanumab and lecanemab. It finds that trials increasingly focus on disease-modifying anti-amyloid/anti-tau therapies and earlier disease stages, while symptomatic, anti-neuroinflammation, and other approaches remain active.

Key findings

  • The FDA granted accelerated approval to aducanumab in June 2021, accelerated approval to lecanemab on January 6, 2023, and traditional approval to lecanemab on July 6, 2023; donanemab had an application for full approval.
  • In the lecanemab Clarity AD trial, CDR-SB difference was −0.45 (95% CI −0.67 to −0.23), amyloid PET burden difference was −59.1 (95% CI −62.6 to −55.6), ADAS-Cog14 mean difference was −1.44 (95% CI −2.27 to −0.61), ADCOMS mean difference was −0.050 (95% CI −0.074 to −0.027), and ADCS-MCI-ADL mean difference was 2.0 (95% CI 1.2 to 2.8); ARIA-E occurred in 12.6% and infusion-related reactions in 26.4%.
  • In TRAILBLAZER-ALZ 2, donanemab produced iADRS change of −6.02 vs −9.27 for placebo in the low/medium tau group and −10.2 vs −13.1 in the combined population, with a reported 60% reduction in decline in early-stage AD; ARIA occurred in 24% vs 2.1% and infusion-related reactions in 8.7% vs 0.5%. In TRAILBLAZER-ALZ 4, 38% of donanemab-treated patients vs 2% of aducanumab-treated patients were below the amyloid positivity threshold at 6 months, plasma pTau217 decreased by 25% with donanemab but not with aducanumab, and ARIA-edema occurred in 22% of both groups.
  • The review reports that most trials continue to target amyloid and tau, with a shift toward prodromal/preclinical populations; BIIB080 produced dose-dependent 30%–50% reductions in CSF total tau and pTau181. Among trials newly registered in the last 4 years, four articles from two trials were published, and both trials had overall low risk of bias.

Methods

  • Narrative review/update of Alzheimer disease clinical trials listed on ClinicalTrials.gov, covering 2020–2023, with tables summarizing ongoing phase 2, phase 3, and phase 4 trials by mechanism.
  • The paper describes trial agents, targets, designs, outcomes, and status; for published results, it identified four articles pertaining to two trials newly registered in the last 4 years and assessed methodological quality using the Cochrane risk of bias tool, version 2.
  • No systematic search, meta-analysis, or pooled effect estimate is described.

Limitations

  • The paper does not state a formal limitations section. Evident from the text: it is a descriptive review relying on ClinicalTrials.gov listings and selected published results, without a systematic search or quantitative synthesis.
  • Many cited trials are ongoing or not yet recruiting, so efficacy and safety results are unavailable; the review notes challenges including limited indications for anti-amyloid monoclonal antibodies, administration and monitoring costs, need for specialized facilities and imaging, and unmet needs for BPSD and cognitive enhancement.
  • Risk-of-bias assessment was limited to four published articles from two trials; other trial data were not quality-assessed.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12929-023-00976-6

Cites

85 of 85 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Fig. 1 According to the amyloid hypothesis, the pathophysiology and clinical course of Alzheimer's disease progress as follows: amyloid accumulation, neuroinflammation, tau accumulation, brain metabolism dysfunction, brain atrophy, cognitive decline (from mild cognitive impairment to dementia), and the development of dementia symptoms. Novel drugs should target at least one of these events. AD Alzheimer's disease, aMCI amnestic mild cognitive impairment, BPSD behavioral psychological symptoms of dementia
Fig. 1 According to the amyloid hypothesis, the pathophysiology and clinical course of Alzheimer's disease progress as follows: amyloid accumulation, neuroinflammation, tau accumulation, brain metabolism dysfunction, brain atrophy, cognitive decline (from mild cognitive impairment to dementia), and the development of dementia symptoms. Novel drugs should target at least one of these events. AD Alzheimer's disease, aMCI amnestic mild cognitive impairment, BPSD behavioral psychological symptoms of dementiaCC BY · PubMed Central
Fig 2. Trends in Phase 3 trials, 2020–2023, categorized according to event-related themes in ClinicalTrials.gov. Left: Number of Phase 3 trials. Right: Percentage of Phase 3 trials. A anti-amyloid therapy, B anti-tau therapy, C neuroprotection, D anti-neuroinflammation, E cognitive enhancer, F relief of behavioral psychological symptoms of dementia, G others, U undisclosed
Fig 2. Trends in Phase 3 trials, 2020–2023, categorized according to event-related themes in ClinicalTrials.gov. Left: Number of Phase 3 trials. Right: Percentage of Phase 3 trials. A anti-amyloid therapy, B anti-tau therapy, C neuroprotection, D anti-neuroinflammation, E cognitive enhancer, F relief of behavioral psychological symptoms of dementia, G others, U undisclosedCC BY · PubMed Central
Fig. 3 Trends in Phase 1 and 2 trials, 2020–2023, categorized according to event-related themes in ClinicalTrials.gov. Left: Number of Phase 2 trials. Right: Number of Phase 1 trials; A anti-amyloid therapy, B anti-tau therapy, C neuroprotection, D anti-neuroinflammation, E cognitive enhancer, F relief of behavioral psychological symptoms of dementia, G others, U undisclosed
Fig. 3 Trends in Phase 1 and 2 trials, 2020–2023, categorized according to event-related themes in ClinicalTrials.gov. Left: Number of Phase 2 trials. Right: Number of Phase 1 trials; A anti-amyloid therapy, B anti-tau therapy, C neuroprotection, D anti-neuroinflammation, E cognitive enhancer, F relief of behavioral psychological symptoms of dementia, G others, U undisclosedCC BY · PubMed Central

Verification

Claims the paper makes

42 Not checked yet · 13 No basis given · 9 Own interpretation · 8 Own result · 4 Own method

Verify all 50 references — free account

Show all 49 claims

  • Probably not a substantial claim. 13
  • It may state two separate claims as one. 18
27 of 27
  • The paper relies on this without support.

    The key event in AD pathogenesis is Aβ accumulation.

    “The key event in AD pathogenesis is believed to be Aβ accumulation.”
  • The paper relies on this without support.

    Remternetug is a monoclonal antibody that recognizes a pyroglutamated form of Aβ that aggregates into amyloid plaques.

    “Remternetug is a monoclonal antibody that recognizes a pyroglutamated form of Aβ that aggregates into amyloid plaques.”
  • The paper relies on this without support.

    The validity of the amyloid hypothesis has been contested.

    “Additionally, the validity of the amyloid hypothesis has been contested, resulting in a significant reduction in the number of anti-amyloid phase 3 trials since 2019.”
  • The paper relies on this without support.

    There is an unmet clinical need for therapies for symptoms including cognitive enhancers and agents for relieving BPSD.

    “This reflects the unmet clinical need for such therapies (Figs. 2 and 3).”
4 of 4

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Percentages, sums and reported differences re-computed from the paper’s own numbers.

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1 of 1

Citations

Cites

Show all 86 references

Research works printed but not linked: 1

  1. Reading CL, Ahlem CN, Murphy MF. NM101 Phase III study of NE3107 in Alzheimer’s disease: rationale, design and therapeutic modulation of neuroinflammation and insulin resistance. Neurodegener Dis Manag. 2021;11(4):289–98. · DOI · Paper page

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Metadata

Authors
Huang, L.-K., Kuan, Y.-C., Lin, H.-W., & Hu, C.-J.
Affiliations
  • Taipei Medical University-Shuang Ho Hospital (TW)
  • National Taiwan University (TW)
  • Taipei Medical University (TW)
Corresponding author
Hu, Chaur-Jong
Venue
Journal of Biomedical Science
Published
2023-10-02
Volume
30
Issue
1
Pages
83-83
ISSN
  • 1021-7770 (ISSN-L)
  • 1423-0127
OpenAlex
W4387259038
Cited by
252
References
86
Citations by year
2026: 54 · 2025: 88 · 2024: 105 · 2023: 5
FWCI
8.99
Type
journal article
Language
en
Open access
Locations
  • Journal of Biomedical Science (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Pharmacology (medical) › Cholinesterase and Neurodegenerative Diseases
Keywords
Alzheimer's disease, clinical trials, new drug development, aducanumab, lecanemab, disease-modifying therapy, amyloid accumulation, neuroinflammation, clinical trial design
MeSH terms
Alzheimer Disease, Humans, Amyloid beta-Peptides

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