Mixing apples and antibodies: when the Cochrane average obscures the evidence in Alzheimer's disease

The recent Cochrane review by Nonino and colleagues provides a timely synthesis of randomized controlled trials of amyloid-β targeting monoclonal antibodies in mild cognitive impairment or mild dementia due to Alzheimer’s disease. The authors should be commended for addressing an area of major clinical and public health relevance. However, we believe that the review’s main interpretation, namely that successful amyloid-β removal “does not seem to be associated with clinically meaningful effects” and that future disease modifying research should focus on other mechanisms, is stronger than the evidence allows and risks misleading clinicians, patients, caregivers and policymakers.