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Name: Simufilam
Synonyms: PTI-125, sumifilam
Chemical Name: 4-benzyl-8-methyl-1,4,8-triazaspiro[4.5]decan-3-one
Therapy Type: Small Molecule (timeline)
Target Type: Amyloid-Related (timeline)
Condition(s): Alzheimer's Disease
U.S. FDA Status: Alzheimer's Disease (Phase 3)
Company: Cassava Sciences


Simufilam binds to filamin, a ubiquitous scaffolding protein and regulator of the actin cytoskeleton. Filamin has been claimed to stabilize the high-affinity interaction of soluble Aβ42 and the α7 nicotinic acetylcholine receptor (α7nAChR), which has been reported to trigger tau phosphorylation and synaptic dysfunction in some experimental systems (Wang et al., 2000; Wang et al., 2003Snyder et al., 2005).

Preclinical studies suggest that PTI-125 prevents and reverses the binding of Aβ42 to α7nAChR. In one, daily infusions of human synthetic Aβ42 into mouse cerebral ventricles resulted in association of Aβ42 and filamin with α7 receptors in the hippocampus and prefrontal cortex. Concomitant intraperitoneal PTI-125 injections prevented this association, reduced tau phosphorylation and amyloid deposition, and normalized signaling through the α7, NDMA, and insulin receptors. PTI-125 reportedly tamped down Aβ-induced inflammatory cytokine release by blocking filamin recruitment to toll-like receptor 4. When applied to human AD postmortem brain tissue, PTI-125 was reported to cause filamin and Aβ42 to dissociate from the α7 receptor (Jul 2012 news). Subsequently, the same group reported that simufilam could inhibit Ab42-induced filamin A interactions with multiple inflammatory receptors (Wang et al., 2023). These studies used immunoprecipitation and western blotting to quantitate protein-protein interactions. One study using fluorescence resonance energy transfer in intact cells reported that simufilam reduced Aβ42 binding to α7 with picomolar potency (Wang et al., 2023).

Two months of oral PTI-125 in 3xTg AD mice reportedly reduced tau hyperphosphorylation, amyloid and tau deposition, and neuroinflammation, and restored synaptic function, nesting behavior, and spatial and working memory relative to untreated mice. The study claimed that Aβ42 induces a conformational change in filamin, which would promote its association with the α7 and toll-like receptors, enabling Aβ42 toxicity and inflammation. PTI-125 was said to preferentially bind altered filamin and normalize its conformation (Wang et al., 2017). Most research on filamin, Aβ42 and Alzheimer's comes from the same laboratory, although several independent studies have implicated filamin in AD and progressive supranuclear palsy (Levert et al., 2023; Aumont et al., 2022; Tsujikawa et al., 2022).


In 2017, Cassava Sciences started with a Phase 1 safety study of 50, 100, or 200 mg of PTI-125 in 24 healthy adults.

In early 2019, the company ran an NIH-funded Phase 2a trial in people with mild to moderate AD. This open-label, multicenter safety, pharmacokinetics, and biomarker study enrolled 13 participants with MMSE scores between 16 and 24 and a CSF total tau/Aβ42 ratio of 0.30 or higher. They took 100 mg PTI-125 capsules twice daily for 28 days. Primary outcomes were pharmacokinetic measures; secondary ones were CSF biomarkers of Alzheimer’s pathology, neurodegeneration, and neuroinflammation. The study measured levels of PTI-125DX, an experimental diagnostic biomarker to indicate altered filamin in blood.

In a September 2019 press release, Cassava claimed that drug treatment significantly decreased CSF total and phosphorylated tauT181, neurofilament light, neurogranin, YKL-40, Il-6, Il-1β, and TNFα, consistent with drug effects countering neurodegeneration and -inflammation. P-tauT181 and neurogranin fell by about a third with treatment, while the inflammatory markers decreased from 5 to 14 percent. Every participant showed changes on most markers with treatment. The ratio of phosphorylated tau to Aβ42 apparently improved. This trial did not measure cognition. At CTAD, the company presented data showing reduction in plasma levels of neurogranin, total tau, neurofilament light, and YLK-40 after treatment. Multiple forms of modified tau declined in plasma, including p-tauT181, p-tauT202, and p-tauT231, as did a nitrated form of tau, n-tauY29 (Dec 2019 conference news). The data were published after peer review (Wang et al., 2020). In a subsequent analysis, the company claimed that simufilam treatment had normalized suboptimal insulin responses in patients’ blood cells by modulating filamin A interaction with the mTOR protein (Wang et al., 2023).

From September 2019 to March 2020, the company ran an NIH-funded Phase 2b study at 10 sites across the U.S. It compared 100 or 50 mg PTI-125 with placebo, dosed twice daily for 28 days, in 64 participants with a clinical diagnosis of mild to moderate AD, confirmed by CSF biomarkers. The primary endpoint was change in CSF phosphorylated tau, neurofilament light chain, neurogranin, total tau, YKL-40, and Aβ42; secondary outcomes include cognition and plasma biomarkers. The randomized period of this trial was followed by an open-label extension for participants who completed previous Phase 2 trials, plus new enrollees to bring its participant number up to 100. This study aimed to gather one-year treatment data on the 100 mg twice-daily dose.

In top-line results announced in May 2020, the 28-day dosing phase missed its primary outcome (press release). In November 2020 at CTAD, data on reanalyzed CSF samples were presented, whereby both doses led to improvements in all CSF biomarkers tested, compared to placebo, with 10 to 40 percent decreases in total tau, p-tau181, neurogranin, NfL, HMGB1, YKL40, IL-6, sTREM2, albumin, and immunoglobulin G. CSF Aβ42 was reported to have risen by about 10 percent. Scores on episodic memory and spatial working memory tests were reported as having improved in treated groups, with effect sizes between 17 and 46 percent. No safety issues were reported (press release). In a poster at the July 2021 AAIC, the company claimed to see a significant reduction in plasma p-tau181 in both treated groups compared to placebo. 

The study confirmed target engagement as defined by reduced association of filamin-A with the α7 and TLR4 receptor in lymphocytes.

In November 2020, the drug's name was changed to simufilam, due to a potential trademark conflict with the previous name (press release).

In February 2021, the company announced interim data from the open-label extension, claiming that 50 patients who had completed six months of dosing improved by 1.6 points on the ADAS-Cog and 1.3 points on the NPI (press release). Adverse events were said to be mild and transient. At the July 2021 AAIC, the company reported on CSF biomarkers measured in 25 people after six months treatment. Aβ42 significantly increased, while total tau, p-tau181, NfL, neurogranin, sTrem2, YKL40, and HMGB1 all significantly decreased between 18 and 72 percent. At the same conference, the company claimed a continued improvement on ADAS-COG11 by 3 points in the first 50 patients who completed nine months of the open-label treatment. 

In mid-2021, Cassava expanded the open-label study from 100 to 200 patients, and added a new extension. Patients who completed one year of open-label simufilam were randomized to further treatment or placebo for six months to assess effects of withdrawal, followed by another six months of open-label treatment. The open-label portion of the study finished in December 2022. Dosing for the placebo-controlled extension was completed in May 2023.

In May 2021, a pharmacokinetic study of formulation and food effects was completed in 24 healthy volunteers.

In November 2021, the company began two Phase 3 trials. One will randomize 750 participants with AD and a clinical dementia rating of 0.5, 1, or 2 to placebo or 100 mg simufilam twice a day for one year, with co-primary outcomes of the ADAS-Cog12 and ADCS-ADL. This trial will run through October 2023. A parallel trial will enroll 1,083 similar patients to be randomized to placebo, 50, or 100 mg simufilam twice a day for 18 months, with the same primary outcomes, and run until June 2024. The company announced an agreement with the FDA on special protocol assessments for these trials of simufilam (press release). In April 2022, the company disclosed the trials had enrolled 60 patients (corporate presentation).

In August 2021, an anonymous citizen petition was filed with the FDA, requesting the agency halt ongoing simufilam trials. The complaint alleged instances of research misconduct involving the clinical trial biomarker data and previous, foundational research on the drug (Endpoint news, FDA website). Soon after, several independent scientists reported instances of apparent data manipulation in several published studies (see PubPeer and Retraction Watch) and in the blood biomarker data on the 2021 AAIC poster (Science Integrity Digest blog). On September 3, the company denied wrongdoing, admitting errors in a figure on the poster but standing by the underlying data analysis and conclusions (see statement, corrected figure). Quanterix, the biomarker testing CRO that analyzed the blood, denied any role in the disputed analysis beyond assaying blinded samples and reporting raw values to Cassava (press release). In January 2022, a New Yorker article on whistleblowers detailed the circumstances surrounding this citizen petition. In February 2022, the FDA rejected the petition on procedural grounds (FDA letter).

In September 2021, a securities fraud class action lawsuit was filed against Cassava Sciences (Yahoo Finance news). In November 2021, the company disclosed that it is the target of an SEC investigation into claims that it manipulated research results on simufilam (WSJ article).

In February, 2022, the journal Neuroscience published an editorial note to a 2005 paper, finding no evidence of data manipulation. In March 2022, the journal PlosOne retracted five papers by Cassava academic collaborator Hoau-Yan Wang at CUNY; although none were related to the AD work, two had been co-authored with a Cassava employee (Wang et al., 2008Wang and Burns, 2009Bakshi et al., 2011Bakshi et al., 2014Stucky et al., 2016). In 2021 and 2022, journals re-examined three of Wang’s papers related to simufilam; none found convincing evidence of data manipulation, according to a Cassava press release.

On 18 April 2022, the New York Times featured simufilam in a news article. On May 5, the company announced that the phase 3 program had thus far enrolled about 120 participants. On July 7, a securities class action case was opened. On July 27, Reuters news agency reported that the U.S. Department of Justice had opened a criminal investigation into whether Cassava Sciences manipulated research results (Reuters news). 

In their August 2022 earnings report, Cassava released additional results on the open-label trial. The first 100 patients to complete at least 12 months treatment reportedly improved their ADAS-COG scores by an average of 1.5 points from baseline. The company also reported that their Phase 3 trials had enrolled more than 500 patients out of an intended 1,750, evenly split between the two studies (press release; September 13 corporate presentation).

In October 2022, a person unaffiliated with Cassava asked the FDA to grant breakthrough therapy designation to simufilam. The agency rejected the request, on the grounds that only the drug sponsor can apply for this designation (FDA letter).

Also in October 2022, the company added an optional, one-year, open-label extension to their Phase 3 trials (press release).

In November 2022, Cassava announced it had filed a defamation lawsuit against the whistleblowers who originated the citizen’s complaint with the FDA, and others (press release).

In January 2023, Cassava announced final results of their open label study (press release). In 200 patients treated for one year or more, ADAS-Cog scores declined by an average of 0.5 points. This was in contrast to previous findings on the first 100 patients, where the company reported an improvement of 1.5 points after one year. The drug remained safe, with no serious adverse events reported. 

In February 2023, the company said 953 patients were enrolled in the Phase 3 trials, just over half the target (press release). In July 2023, the company reported topline results of the six-month withdrawal study involving 157 patients (press release). The primary outcome of change in the ADAS-Cog was not statistically significantly different between drug continuation and withdrawal groups.

In October 2023, Science magazine reported that the City University of New York had accused Wang of research misconduct involving 20 research papers, including work that formed the basis for simufilam’s clinical development (Science articleWSJ story). The news story was based on a confidential draft report. The leak of the report and other questions about the integrity of the investigation led the University to pause its inquiry (statement; NYT article). In a press release, Cassava denied wrongdoing. 

In November 2023, the company announced that enrollment was complete in both Phase 3 trials (press release).

For details of registered trials, see

Clinical Trial Timeline

  • Phase 2
  • Study completed / Planned end date
  • Planned end date unavailable
  • Study aborted
Sponsor Clinical Trial 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034
Cassava Sciences NCT04079803

Last Updated: 04 Dec 2023


  1. A correction: In 2020, CSF data were not reanalyzed; backup CSF samples were reanalyzed, producing new data that did not show unexpectedly large changes over one month in placebo patients as the prior analysis did, nor improvements in some biomarkers concurrent with worsening in other biomarkers in the same patients. In short, the second analysis showed high correlations between biomarkers in changes from baseline. The first analysis showed no correlation between biomarkers in change from baseline (r=0.06 on average in placebo only).

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News Citations

  1. Fluid AD Biomarkers Link P-Tau to Synapses, Inflammation
  2. Novel Drug Knocks Aβ Off Synapses, Reduces Toxicity

Research Models Citations

  1. 3xTg

Paper Citations

  1. . PTI-125 Reduces Biomarkers of Alzheimer's Disease in Patients. J Prev Alzheimers Dis. 2020;7(4):256-264. PubMed.
  2. . Simufilam suppresses overactive mTOR and restores its sensitivity to insulin in Alzheimer's disease patient lymphocytes. Front Aging. 2023;4:1175601. Epub 2023 Jun 29 PubMed.
  3. . High-affinity naloxone binding to filamin a prevents mu opioid receptor-Gs coupling underlying opioid tolerance and dependence. PLoS One. 2008 Feb 6;3(2):e1554. PubMed. RETRACTED
  4. . Naloxone's pentapeptide binding site on filamin A blocks Mu opioid receptor-Gs coupling and CREB activation of acute morphine. PLoS One. 2009;4(1):e4282. Epub 2009 Jan 27 PubMed. RETRACTED
  5. . Prenatal cocaine exposure increases synaptic localization of a neuronal RasGEF, GRASP-1 via hyperphosphorylation of AMPAR anchoring protein, GRIP. PLoS One. 2011;6(9):e25019. Epub 2011 Sep 27 PubMed. RETRACTED
  6. . Prenatal cocaine exposure uncouples mGluR1 from Homer1 and Gq Proteins. PLoS One. 2014;9(3):e91671. Epub 2014 Mar 13 PubMed. RETRACTED
  7. . Prenatal Cocaine Exposure Upregulates BDNF-TrkB Signaling. PLoS One. 2016;11(8):e0160585. Epub 2016 Aug 5 PubMed. RETRACTED
  8. . beta-Amyloid(1-42) binds to alpha7 nicotinic acetylcholine receptor with high affinity. Implications for Alzheimer's disease pathology. J Biol Chem. 2000 Feb 25;275(8):5626-32. PubMed.
  9. . Alpha 7 nicotinic acetylcholine receptors mediate beta-amyloid peptide-induced tau protein phosphorylation. J Biol Chem. 2003 Aug 22;278(34):31547-53. PubMed.
  10. . Regulation of NMDA receptor trafficking by amyloid-beta. Nat Neurosci. 2005 Aug;8(8):1051-8. PubMed.
  11. . Simufilam Reverses Aberrant Receptor Interactions of Filamin A in Alzheimer's Disease. Int J Mol Sci. 2023 Sep 11;24(18) PubMed.
  12. . PTI-125 binds and reverses an altered conformation of filamin A to reduce Alzheimer's disease pathogenesis. Neurobiol Aging. 2017 Jul;55:99-114. Epub 2017 Mar 31 PubMed.
  13. . Direct and Indirect Effects of Filamin A on Tau Pathology in Neuronal Cells. Mol Neurobiol. 2023 Feb;60(2):1021-1039. Epub 2022 Nov 18 PubMed.
  14. . Evidence of Filamin A loss of solubility at the prodromal stage of neuropathologically-defined Alzheimer's disease. Front Aging Neurosci. 2022;14:1038343. Epub 2022 Nov 24 PubMed.
  15. . Actin-binding protein filamin-A drives tau aggregation and contributes to progressive supranuclear palsy pathology. Sci Adv. 2022 May 27;8(21):eabm5029. Epub 2022 May 25 PubMed.

External Citations

  1. press release
  2. press release
  3. press release
  4. poster
  5. press release
  6. press release
  7. press release
  8. corporate presentation
  9. Endpoint news
  10. FDA website
  11. PubPeer
  12. Retraction Watch
  13. Science Integrity Digest blog
  14. statement, corrected figure
  15. press release
  16. New Yorker article
  17. FDA letter
  18. Yahoo Finance news
  19. WSJ article
  20. editorial note
  21. Cassava press release
  22. news article
  23. announced
  24. securities class action
  25. Reuters news
  26. press release
  27. corporate presentation
  28. FDA letter
  29. press release
  30. press release
  31. press release
  32. press release
  33. press release
  34. Science article
  35. WSJ story
  36. statement
  37. NYT article
  38. press release
  39. press release

Further Reading


  1. . Altered filamin A enables amyloid beta induced tau hyperphosphorylation and neuroinflammation in Alzheimer’s disease. Neuroimmunol Neuroinflammation 2017;4:263-71.
  2. . Filamin A inhibition reduces seizure activity in a mouse model of focal cortical malformations. Sci Transl Med. 2020 Feb 19;12(531) PubMed.
  3. . Filamin-A and Myosin VI colocalize with fibrillary Tau protein in Alzheimer's disease and FTDP-17 brains. Brain Res. 2010 Jul 23;1345:182-9. PubMed.