알츠하이머병에서 항아밀로이드 치료제 개발의 여정과 최근 임상적 성과

초록

Alzheimer’s disease (AD) is the leading cause of dementia worldwide, with rapidly growing prevalence and socioeconomic burden, particularly in aging societies such as South Korea. The amyloid cascade hypothesis has long emphasized amyloid-β (Aβ) deposition in AD pathogenesis. Many therapeutic strategies targeting Aβ production, aggregation, or clearance—such as active immunization, monoclonal antibodies (bapineuzumab, solanezumab, gantenerumab, crenezumab), and β- or γ-secretase inhibitors—failed to show meaningful clinical benefit or were halted due to safety issues including amyloid-related imaging abnormalities. Despite these set backs, recent trials of lecanemab and donanemab demonstrated significant slowing of cognitive decline, resulting in FDA approval, with lecanemab also launched in South Korea. New candidates including remternetug, trontinemab, and sabirnetug are under devel opment. This review summarizes the developmental history and lessons learned from anti-amyloid therapies, discusses the signifi cance of recent advances, and considers future directions including early intervention, multi-target strategies, biomarker-based preci sion approaches, and health-policy implications.

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