Do not trade this blog as 4 billion years of evolution is against me and possibly even God laughs at it, He has a great sense of humor!
The first line of $CRTX PR said that primary edpoints have not been achieved and a 80% selloff commenced. On Wall Street deep thinking and considerations of nuances of medicine are dangerous things. Beefore we progress any further I suggest you read my post on epidemiology of dementia which references a British paper on dementia and demographics of diagnosed and dying with the deiagnosis. Link  https://piotrpeterblog.com/2021/04/11/the-ideal-dementia-drug-and-dementia-patients-population/ . Another piece you should read is the press release from $CRTX. Link https://www.cortexyme.com/cortexyme-reports-gain-trial-data-demonstrated-relationship-between-reduction-of-p-gingivalis-infection-and-slowing-of-alzheimers-disease-progression/ and view the CTAD 2021 presentation. Link https://ir.cortexyme.com/events/event-details/14th-clinical-trials-alzheimers-disease-conference-ctad-2021-late-breaking.
There are two aspects of Atuzaginstat failure/success. It failed to prove itself be the cause of all dementia or Alzheimer’s but it proved itself to work on P.gingivalis infection. More on the latter soon but I assume there is the success already baked into the cake. Considering the former, it seems that P.gingivalis for some patients plays part in the dementia. We can not dismiss P.gingivalis contribution to patient’s dementia progress, making Atuzaginstat part of future Alzheimer’s or dementia drug arsenal.
Nobody on Wall Street Pays Attension to Dementia Epidemiology
From the reference  the mean average duration of dementia or Alzheimer’s disease is just few years till death. Most patients are diagnosed in advanced age with already low MMSE scores and they deteriorate quickly requiring 24h care. We all were suprised by the conditional approval of $BIIB’s Aduhelm. One of the explanations of this controvertial decicion is the fore-mentioned epidemiology of the disease. Of course, $CRTX does not have the clout of $BIIB and most likely FDA will ask it to run another trial, but then the biomarker makes this a trivial exercise of beaucratic power, and more like a barrier to $BIIB competition.
The 57% reduction in decline rate seems like not much an achievent versus the projected results of AVXL’s Blarcamesine, its implications are that Atuzaginstat can buy some time for the patients. In the presentation at CTAD 2021 $CRTX two important things were saif regarding Atuzaginstat. Namely, that both mild and moderate (12-18 MMSE scores) patients responded, and that we are witnessing segragation of outcomes of diffrent drugs to particular groups of Alzheimer’s patinents. Regarding the latter, Blarcamesine is effective with those who are carring the right biomarkers and are MMSE grreater than 20. On the therapeutic horizon looms the possibility of slew of dementia or Alzheimer’s drugs being matched by practitioners to specific biomarker carries or responders. FDA should approve Atuzaginstat but soon we will witness the strength of $CRTX arguments.
I do not think that Alzheimer’s or dementia are main markets for Atuzaginstat or many new gingipain proteases blockers. The market for those lies in the vast population of those afffected by peridontal disease or infection, 50% of population over 35 years. The established or nascent links of the infection to other health problems like hearth disease and liver NASH might be incalculable to its value. Of course, had not other drugs displace Atuzaginstat or alternative etiologies make these obsolete this drug can be a real blockbuster. The pipline promises improved therapeutic effect and patent portfolio gives the propection neccesary for building value.
On personal note, I am going to keep my $CRTX tiny position for few years even if I am now in the red.