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Even in Biogen’s most optimistic take on the results — looking only at patients who got the highest dose for the longest period of time — aducanumab outperformed placebo by just 0.5 points on a three-point scale of dementia. To skeptics, that’s a minuscule effect unlikely to provide meaningful benefits to patients with Alzheimer’s. The doctors on stage agreed that it was substantial and meaningful.

The new details Biogen released about the safety profile of the drug may also sharpen questions about its prospects. In the Emerge study, about 35% of patients who got the high dose experienced form of brain swelling known as amyloid-related imaging abnormalities, or ARIA, compared to 25% who got the low dose group. Those who experienced symptoms had issues that were “generally mild,” including headache, dizziness, visual disturbances, nausea, and vomiting, Budd Haeberlein said. While there were 16 deaths across the two studies, none of the deaths was related to ARIA.

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