Solanezumab does not appear to slow cognitive decline in patients with mild Alzheimer’s disease, according to the newly-published results of the EXPEDITION-3 trial (Honig et al. N Engl J Med 2018;378:321-330). Prior studies also failed to show a benefit.
Solanezumab is a monoclonal antibody targeting soluble beta-amyloid, promoting efflux of beta-amyloid from the brain to the plasma (sink effect). In the EXPEDITION-1 and -2 trials in mild-to-moderate Alzheimer’s disease (n=2052), solanezumab 400 mg IV q4 weeks for 18 months failed to show significant improvement versus placebo in change from baseline to week 80 in the 11-item ADAS-cog scale score; the treatment effect was -0.8 points and -1.3 points in the two trials (Doody et al. N Engl J Med 2014;370:311-321).