This Week in Neurology: Alzheimer's Trials, MS Dosing, and Stroke Interventions

From the New England Journal of Medicine, a trial reported that oral semaglutide failed to slow clinical progression in early Alzheimer's disease across global phase 3 trials ^[1].

The authors describe findings where the drug did not improve cognitive decline or functional status over one year when compared to placebo. Meanwhile, attention turned to multiple sclerosis therapies in Lancet, where a separate study examined high-dose ocrelizumab dosing strategies ^[2].

This phase 3b randomized controlled trial involved 860 and 753 patients with relapsing or primary progressive multiple sclerosis, finding that high-dose ocrelizumab did not significantly reduce the time to disability progression versus the 600 mg standard dose.

Elsewhere this week in Lancet, researchers presented contrasting data regarding the same medication in a different patient population ^[5].

A phase 3b trial evaluated intravenous ocrelizumab versus placebo specifically in patients with primary progressive multiple sclerosis. The study found that ocrelizumab significantly reduced the risk of disability progression in this specific group compared to placebo. These adjacent reports suggest that dosing and disease subtype may critically influence therapeutic outcomes for ocrelizumab.

We also saw research in Neurological sciences regarding rehabilitation strategies for post-stroke recovery ^[3].

A systematic review and meta-analysis synthesized evidence on exercise for post-stroke cognitive impairment. It found that exercise interventions, particularly aerobic and task-based programs, offered cognitive and motor benefits. In a separate investigation from the European journal of clinical pharmacology, a meta-analysis looked at extended window treatments for acute ischemic stroke ^[4].

The analysis of 4000 adults treated with IV tenecteplase beyond 4.5 hours or for wake-up strokes found modest gains in functional recovery, though the treatment significantly increased the risk of symptomatic intracranial hemorrhage.