# Network meta-analysis of the efficacy of nine drugs for cognitive function in patients with Alzheimer's disease

## TL;DR

This study compares nine drugs for Alzheimer's disease and finds no strong evidence that they improve cognitive function more than a placebo.

## Contribution

The study provides a network meta-analysis ranking nine Alzheimer's drugs based on cognitive outcomes.

## Key findings

- No drug showed statistically significant superiority over placebo in primary cognitive outcomes.
- Semorinemab and tilavonemab had the highest rankings but no significant pairwise advantage.
- Aducanumab showed a modest benefit on MMSE, but results may be biased by publication bias.

## Abstract

Alzheimer's disease (AD) remains a global challenge, and the comparative cognitive efficacy of emerging pharmacotherapies is still unclear.

To compare and rank nine pharmacological agents against placebo in AD with respect to key cognitive outcomes using a network meta-analysis.

We systematically searched randomized controlled trials published up to May 2025 that evaluated aducanumab, lecanemab, donanemab, gosuranemab, semorinemab, tilavonemab, zagotenemab, masupirdine, or sodium oligomannate in AD. The primary outcomes were Clinical Dementia Rating–Sum of Boxes (CDR-SB) and Alzheimer's Disease Assessment Scale–Cognitive Subscale (ADAS-cog); Mini-Mental State Examination (MMSE) was a secondary outcome. Treatments were ranked using the Surface Under the Cumulative Ranking curve (SUCRA).

Fifteen randomized trials encompassing 33 treatment arms were included. No drug demonstrated statistically robust superiority over placebo in primary outcomes. Semorinemab and tilavonemab achieved highest SUCRA rankings, but without significant pairwise advantage. For MMSE, aducanumab showed a modest mean difference versus placebo (1.98, 95% CI 0.03–3.93), though evidence of publication bias reduced confidence.

Current pharmacological treatments do not consistently outperform placebo in AD. Tau-targeted antibodies (semorinemab, tilavonemab) display modest but non-significant promise, whereas aducanumab's apparent benefit is likely confounded by publication bias. Further large, rigorous randomized controlled trials and improved preclinical models are essential.