PT - JOURNAL ARTICLE AU - John G Rizk AU - John C Lewin TI - FDA’s dilemma with the aducanumab approval: public pressure and hope, surrogate markers and efficacy, and possible next steps AID - 10.1136/bmjebm-2022-111914 DP - 2022 Apr 21 TA - BMJ Evidence-Based Medicine PG - bmjebm-2022-111914 4099 - http://ebm.bmj.com/content/early/2022/05/16/bmjebm-2022-111914.short 4100 - http://ebm.bmj.com/content/early/2022/05/16/bmjebm-2022-111914.full AB - Accelerating Food and Drug Administration (FDA) product approval to market based on surrogate markers in the absence of proven efficacy creates a risk of adverse outcomes for affected patients, even in response to a life-threatening condition, such as in this case, Alzheimer’s disease. FDA’s recent unexpected approval of aducanumab, despite the unified opposition of its own highly respected advisory committee after the early termination of two efficacy trials, creates the potential risk of adverse effects and lack of clinical efficacy at very high costs. In view of these concerns, a thorough review of the issues and pressures that led to this decision is worth the careful consideration of the clinical and scientific communities with regard to whether this approval represents a calculated and balanced compassionate decision versus a disturbing precedent.