Lessons learned from the failure of solanezumab as a prospective treatment strategy for Alzheimer’s disease

IntroductionIn the last decade, the efforts conducted for discovering Alzheimer's Disease (AD) treatments targeting the best-known pathogenic factors [amyloid-beta (A beta), tau protein, and neuroinflammation] were mostly unsuccessful. Given that a systemic failure of A beta clearance was supposed to primarily contribute to AD development and progression, disease-modifying therapies with anti-A beta monoclonal antibodies (e.g. solanezumab, bapineuzumab, gantenerumab, aducanumab, lecanemab and donanemab) are ongoing in randomized clinical trials (RCTs) with contrasting results.Areas coveredThe present Drug Discovery Case History analyzes the failures of RCTs of solanezumab on AD. Furthermore, the authors review the pharmacokinetics, pharmacodynamics, and tolerability effect of solanezumab from preclinical studies with its analogous m266 in mice. Finally, they describe the RCTs with cognitive, cerebrospinal fluid and neuroimaging findings in mild-to-moderate AD (EXPEDITION studies) and in secondary prevention studies (A4 and DIAN-TU).Expert opinionSolanezumab was one of the first anti-A beta monoclonal antibodies to be tested in preclinical and clinical AD showing to reduce brain A beta level by acting on soluble monomeric form of A beta peptide without significant results on deposits. Unfortunately, this compound showed to accelerate cognitive decline in both asymptomatic and symptomatic trial participants, and this failure of solanezumab further questioned the A beta cascade hypothesis of AD.