I feel like $biib aducanumab has a decent shot, but im not in love with their trial design. the biomarker entry criteria is an important step, moving up into the early and prodromal stage is an important step, but I feel that the duration of treatment may not be long enough. I would have preferred to see a 30 or 36 month tx duration as opposed to 18 months. The pathology of the disease has been progressing, even in these early patients, for 20 yrs. Longer wouldve have given the trial a higher probability of success. I dont see a lot of differentiation from aducanumab and bapineuzumab, apart from $biib heavily benefited by Elan/JnJ being 1st, maybe studying disease too late, being too early for good biomarkers, and paving the way regarding ARIA/vasogenic edma as a marker for efficacy.
Solanezumab is an inferior antibody to both of those, and thats why it failed IMHO. It only targeted soluble forms, but aggregated amyloid and insoluble plaque are also bad players. Adu and bapi target all species.
CDR-SB is superior to ADAS COg because it is a bit less subjective and measures both cognition and function.
There are 2 other antibodies to keep eyes on. Ganterumab from ROche, which is somewhat similar to aducanumab and bapineuzumab, as well as crenezumab from Genentech. Crenezumab has reduced effector function and therefore believed to be able to dose higher without causing ARIA/VE.
one of these antibodies will eventually suceed imho. im surprised that JnJ hasnt taken bapineuzumab off the shelf now that trials in pre-symptomatic patients are easier to conduct.
