Endothelin Receptor Antagonists Show Promise in IgA Nephropathy Treatment
Table of Contents
- Endothelin Receptor Antagonists Show Promise in IgA Nephropathy Treatment
- The Underutilization of ERAs in IgA Nephropathy Treatment
- Clinical Benefits of Endothelin Receptor Antagonists
- potential Risks and Mitigation Strategies
- Emerging ERAs and Real-World Data
- The Broader Implications for Kidney Disease Treatment
- The Evolution of IgA Nephropathy Treatment
- Frequently asked Questions About iga Nephropathy and ERAs
- What is IgA nephropathy?
- How do endothelin receptor antagonists (ERAs) help treat IgA nephropathy?
- What are the benefits of using eras for IgA nephropathy?
- What are the potential side effects of ERAs?
- Which ERAs are currently available or in development for treating IgA nephropathy?
- Are ERAs effective in real-world clinical practice for IgA nephropathy?
New research indicates that endothelin receptor antagonists (ERAs) and dual endothelin-angiotensin receptor antagonists (Dears) could considerably improve outcomes for patients with IgA nephropathy. these medications, though available for decades, are underutilized despite demonstrating clear benefits in reducing albuminuria, a key indicator of kidney damage. A recent presentation highlighted that a majority of clinicians do not regularly prescribe ERAs or dears for IgA nephropathy.
The Underutilization of ERAs in IgA Nephropathy Treatment
During a session on ‘Game Changers in IgA Nephropathy,’ Hiddo Heerspink (UMCG) discussed the potential of ERAs and Dears. A poll revealed that over 70% of the audience did not routinely use these medications, while only 15% regularly considered them for their patients. This is despite the fact that ERAs have been available for over 30 years.
Did You know? IgA nephropathy affects approximately 2.5 people per 100,000 worldwide each year, and is a leading cause of kidney failure.
Clinical Benefits of Endothelin Receptor Antagonists
Studies have consistently shown that ERAs can reduce albuminuria by 30-40% when added to renin-angiotensin system (RAS) inhibitors or SGLT2 inhibitors. This reduction in albuminuria translates to an almost 30% decrease in the risk of adverse composite endpoints across various studies. Albuminuria is a key marker of kidney disease progression, and reducing it can significantly improve patient outcomes.
The National Kidney Foundation reports that reducing albuminuria is a primary target in managing chronic kidney disease to slow its progression and prevent complications. 1
potential Risks and Mitigation Strategies
one of the main concerns with ERAs is their potential to cause fluid retention, which can lead to heart failure in severe cases. To mitigate this risk, Heerspink advised using eras that selectively target endothelin-A receptors at low dosages, possibly in combination with an SGLT2 inhibitor. This approach is best suited for patients without an elevated risk of fluid retention.
Pro Tip: Regular monitoring of fluid balance and kidney function is crucial when using ERAs, especially in patients with pre-existing cardiovascular conditions.
Emerging ERAs and Real-World Data
Currently,three selective eras and Dears are either developed or approved for use: Sparsentan (Protect-Trial),Atrasentan (Align),and SC0062 (Succed). While some trials are ongoing, preliminary results indicate that these drugs effectively reduce albuminuria, increase the likelihood of complete remission, and do not significantly increase the risk of edema, weight gain (due to fluid retention), or changes in pro-BNP levels.
Recent real-world data for Sparsentan (n = 23) confirms that the benefits observed in clinical trials translate into clinical practice. This data supports the use of Sparsentan in combination with SGLT2 inhibitors for managing IgA nephropathy. 2
The Broader Implications for Kidney Disease Treatment
Heerspink concluded that eras and Dears could be valuable in the early stages of not only IgA nephropathy but also chronic kidney damage from other causes. Early intervention with these medications may help slow disease progression and improve long-term outcomes.
| drug | Trial | Mechanism | Observed Benefits |
|---|---|---|---|
| Sparsentan | Protect-Trial | Dual endothelin-angiotensin receptor antagonist | Reduces albuminuria, increases remission |
| Atrasentan | Align | Selective endothelin-A receptor antagonist | Reduces albuminuria |
| SC0062 | Succed | Selective endothelin-A receptor antagonist | Reduces albuminuria |
What are your thoughts on the potential of ERAs in treating kidney diseases? How can clinicians be encouraged to adopt these therapies more widely?
The Evolution of IgA Nephropathy Treatment
IgA nephropathy, also known as Berger’s disease, has historically been managed with supportive care, including blood pressure control and lifestyle modifications. The introduction of RAS inhibitors marked a significant advancement, but manny patients still progress to kidney failure.The emergence of SGLT2 inhibitors and now ERAs represents a new era in targeted therapies aimed at slowing disease progression and improving patient outcomes.The ongoing research and clinical trials are crucial in refining treatment strategies and identifying the patients who will benefit most from these novel approaches.
Frequently asked Questions About iga Nephropathy and ERAs
What is IgA nephropathy?
IgA nephropathy is a kidney disease that occurs when an antibody called immunoglobulin A (IgA) builds up in the kidneys,causing inflammation and potentially leading to kidney damage.
How do endothelin receptor antagonists (ERAs) help treat IgA nephropathy?
Endothelin receptor antagonists (ERAs) work by blocking the effects of endothelin, a substance that can cause blood vessels to narrow and contribute to kidney damage. By blocking endothelin, ERAs can definitely help reduce albuminuria (protein in the urine) and slow the progression of IgA nephropathy.
What are the benefits of using eras for IgA nephropathy?
The benefits of using ERAs include a significant reduction in albuminuria, which can lead to a lower risk of composite endpoints such as kidney failure. Studies have shown that ERAs can reduce albuminuria by 30-40% when added to standard treatments like ACE inhibitors or SGLT2 inhibitors.
What are the potential side effects of ERAs?
Potential side effects of ERAs include fluid retention,which in severe cases can lead to heart failure.Though,selective ERAs used in low dosages,especially when combined with SGLT2 inhibitors,can minimize these risks.
Which ERAs are currently available or in development for treating IgA nephropathy?
Several selective ERAs and dual endothelin-angiotensin receptor antagonists (Dears) have been developed or approved for use, including sparsentan, Atrasentan, and SC0062. These drugs have shown promise in reducing albuminuria and increasing the likelihood of complete remission in clinical trials.
Are ERAs effective in real-world clinical practice for IgA nephropathy?
Yes, recent real-world data for Sparsentan indicates that the benefits observed in clinical trials translate into practical clinical settings, suggesting that ERAs can be a valuable addition to the treatment regimen for IgA nephropathy.
Disclaimer: This article provides data about recent research in IgA nephropathy treatment and should not be considered medical advice. Consult with a healthcare professional for personalized guidance.
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