A sweeping Cochrane review concluded that anti-amyloid antibody drugs in Alzheimer’s disease produce “no meaningful difference” for patients with mild cognitive impairment or mild dementia. The analysis compiles evidence across randomized controlled trials and directly challenges the clinical benefit narrative that has supported years of drug development. The backlash is immediate in both scientific and regulatory discussions, as the findings collide with prior perceptions that amyloid targeting could modify disease progression. The renewed debate also comes alongside the FDA revisiting related peptide frameworks, adding pressure to the agency and sponsors around evidence standards. For the Alzheimer’s pipeline, the key message is that independent syntheses are increasingly shaping expectations for meaningful clinical outcomes—not just biomarkers or surrogate endpoints.