Recent advances in symptomatic management and immunotherapies for Alzheimer's disease treatment: a narrative review

초록

Purpose: Alzheimer's disease (AD) is the most prevalent neurodegenerative disorder characterized by progressive cognitive decline and loss of functional independence. South Korea became a super-aged society in 2024, increasing the need for effective therapeutic strategies for AD. Conventional treatments, including cholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists, primarily provide symptomatic relief and do not modify the disease progression. Given the central role of amyloid-beta accumulation in AD pathogenesis, monoclonal antibodies targeting amyloid aggregates have emerged as a major focus of therapeutic development. This review summarized current pharmacologic treatments for ADand clinical guidance for lecanemab and donanemab.<br /> Current Concepts: Among emerging disease-modifying therapies, lecanemab and donanemab have demonstrated clinical efficacy and acceptable safety profiles in large-scale clinical trials, leading to regulatory approval Lecanemab was approved for use in South Korea in 2024, whereas donanemab is currently undergoing bridge clinical trials. Recently published expert guidelines from both the United States and South Korea provide structured recommendations regarding patient eligibility, neuroimaging requirements, and treatment monitoring, offering a standardized framework for clinical implementation.<br /> Discussion and Conclusion: Anti-amyloid immunotherapies represent a substantial advance in the treatment landscape of AD. Although adverse events, including amyloid-associated imaging abnormalities, necessitate rigorous patient selection and longitudinal monitoring. Continued accumulation of real-world data and long-term observational evidence will be essential for clarifying therapeutic effectiveness beyond clinical trials and for refining safe treatment strategies. Collectively, these efforts will be critical to optimizing the role of monoclonal antibody therapies in the evolving management of AD.

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