Alzheimer’s Disease: Key Insights from Two Decades of Clinical Trial Failures
Open accessAbstract
Given the acknowledged lack of success in Alzheimer's disease (AD) drug development over the past two decades, the objective of this review was to derive key insights from the myriad failures to inform future drug development. A systematic and exhaustive review was performed on all failed AD compounds for dementia (interventional phase II and III clinical trials from ClinicalTrials.gov) from 2004 to the present. Starting with the initial ∼2,700 AD clinical trials, ∼550 trials met our initial criteria, from which 98 unique phase II and III compounds with various mechanisms of action met our criteria of a failed compound. The two recent reported phase III successes of aducanumab and oligomannate are very encouraging; however, we are awaiting real-world validation of their effectiveness. These two successes against the 98 failures gives a 2.0% phase II and III success rate since 2003, when the previous novel compound was approved. Potential contributing methodological factors for the clinical trial failures were categorized into 1) insufficient evidence to initiate the pivotal trials, and 2) pivotal trial design shortcomings. Our evaluation found that rational drug development principles were not always followed for AD therapeutics development, and the question remains whether some of the failed compounds may have shown efficacy if the principles were better adhered to. Several recommendations are made for future AD therapeutic development. The whole database of the 98 failed compounds is presented in the Supplementary Material.
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Aducanumab received accelerated approval by the FDA for the treatment of mild cognitive impairment due to AD and mild AD dementia on 7 June 2021.
“This led to the accelerated approval of Aducanumab by the FDA for the treatment of mild cognitive impairment due to AD and mild AD dementia on 7 June 2021.”
From Treatment of Alzheimer’s Disease: Beyond Symptomatic Therapies (2023) · cites this paper as [47]
The Introduction (page not provided) says the FDA approved aducanumab in 2021 based on the surrogate endpoint of reduced brain Aβ plaques, with a post-marketing trial required. It does not give 7 June as the approval date or specify mild cognitive impairment due to AD and mild AD dementia as the treatment population. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe approval of the first mAb against AD was given without a definitively proven clinical benefit based on its effects on AD biomarkers.
“The approval of the first mAb against AD was given without a definitively proven clinical benefit based on its effects on AD biomarkers [47,62,64,65].”
From Treatment of Alzheimer’s Disease: Beyond Symptomatic Therapies (2023) · cites this paper as [47]
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Retrospective Bayesian Evidence of Null Effect in Two Decades of Alzheimer’s Disease Clinical Trials
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de Munter, J., Chaprov, K., Lang, E., Sitdikova, K., Wolters, E. C., Svirin, E. P., Kassenova, A., Tsoy, A., Kramer, B. W. W., Askarova, S., et al. (2025) · Cells · doi:10.3390/cells14151168 · Cited by 5 · see citing works
- Authors
- Kim, C. K., Lee, Y. R., Ong, L., Gold, M., Kalali, A., & Sarkar, J.
- Affiliations
- Holmusk, New York, NY, USA
- AbbVie (United States) (US)
- Chairman, CNS Summit, San Diego, CA, USA
- Corresponding author
- Kim, C. Kwon
- Venue
- Journal of Alzheimer s Disease
- Publisher
- SAGE Publications
- Published
- 2022-05-03
- Volume
- 87
- Issue
- 1
- Pages
- 83-100
- ISSN
- 1387-2877 (ISSN-L)
- 1875-8908
- PMC
- PMC9198803
- OpenAlex
- W4220705385
- Cited by
- 241
- References
- 86
- Citations by year
- 2026: 60 · 2025: 71 · 2024: 57 · 2023: 43 · 2022: 10
- FWCI
- 6.29
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Alzheimer s Disease (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Cleveland Clinic
- Topics
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Pharmacology › Cholinesterase and Neurodegenerative Diseases
- Keywords
- Alzheimer's disease, drug development failure
- MeSH terms
- Alzheimer Disease, Humans
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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