The Annual Meeting of the American Society of Nephrology, Kidney Week 2019
The annual meeting of the American Society of Nephrology was held from Nov. 7 to 10 in Washington, D.C., and attracted approximately 13,000 participants from around the world, including nephrology specialists, researchers, scientists, and other health care professionals. The conference featured presentations focusing on the latest advances in the management of patients with kidney diseases and related disorders.
In the ATHENA trial, Paolo Cravedi, M.D., of the Icahn School of Medicine at Mount Sinai in New York City, and colleagues found that mycophenolate mofetil (MMF) and azathioprine (AZA) maintenance therapy were equally effective in preventing acute and chronic rejection in 233 kidney transplant recipients. The recipients were induced with basiliximab plus low-dose thymoglobulin and were maintained on a steroid-free immunosuppressive regimen with lower than conventional doses of cyclosporine.
“This finding, together with the fact that the rate of subclinical rejections in surveillance biopsies was similar in the MMF and AZA treatment arms, demonstrates that compared to AZA, MMF offers no additional protective effect against allograft rejection, also in the setting of minimized maintenance immunosuppression,” Cravedi said. “Due to the lower costs, AZA represents a valuable alternative to MMF also on low-dose maintenance immunosuppression in kidney transplant recipients. Generic formulations for MMF are now available. However, use of generic formulations for drugs with a narrow therapeutic index, such as immunosuppressants, is quite controversial.”
In another study, Alessandro Doria, M.D., of the Joslin Diabetes Center in Boston, and colleagues found that lowering serum uric acid with allopurinol is not effective for preventing diabetic kidney disease (DKD) or slowing its progression in people with type 1 diabetes and mild-to-moderate DKD.
“In this study, three years of treatment with the uric-acid lowering drug allopurinol reduced serum uric acid levels by 35 percent. However, this did not translate into any significant difference in kidney function at the end of the trial between treated and untreated subjects,” Doria said. “Allopurinol should not be considered as an intervention to prevent or slow DKD in patients with type 1 diabetes.”
Finnian McCausland, M.D., of Brigham and Women’s Hospital in Boston, and colleagues found that sacubitril/valsartan compared with valsartan alone resulted in a 50 percent lower risk for renal events in patients with heart failure and preserved left ventricular ejection fraction.
“Heart failure with preserved ejection fraction accounts for half of heart failure cases, is increasing in prevalence, and is associated with high rates of morbidity and mortality. Kidney disease is common in patients with heart failure, and associated with a higher risk of adverse events, compared to those without kidney disease. In these analyses, we examined the effect of sacubitril/valsartan (versus valsartan) on renal outcomes from the PARAGON-HF trial,” McCausland said. “We found that sacubitril/valsartan resulted in a 50 percent lower risk of renal events (composite of ≥50 percent sustained decline in estimated glomerular filtration rate [eGFR], end-stage renal disease, or death from renal causes). Furthermore, sacubitril/valsartan resulted in a slower decline in renal function, as determined by the slope of eGFR during the study period.”
In addition, in terms of the cardiovascular outcomes (total heart failure hospitalizations and cardiovascular death), the investigators found that sacubitril/valsartan was beneficial for patients with lower baseline eGFR compared with valsartan alone.
“Overall, these findings suggest renal benefits from sacubitril/valsartan in patients with heart failure, across the spectrum of ejection fraction,” McCausland concluded. “Further studies are necessary to determine the mechanisms underlying the benefit, and to determine if such benefits persist in patients with eGFR lower than those allowed in the trial.”
The study was funded by Novartis, the manufacturer of sacubitril/valsartan.
Brad Rovin, M.D., of The Ohio State University Wexner Medical Center in Columbus, and colleagues found that the addition of the B-cell-depleting monoclonal antibody, obinutuzumab, to standard of care therapy for proliferative lupus nephritis improved the renal response rate without increasing infections or adverse events.
“We found that at 52 weeks, the number of complete renal responses in the obinutuzumab arm was greater than the placebo arm, with a P value lower than the prespecified alpha. At week 76, the separation between the obinutuzumab-treated patients and placebo-treated patients widened further, and was highly statistically significant. Week 104 results will be available soon,” Rovin said. “This was a phase 2 trial and will need to be replicated in a larger phase 3 trial, which is already planned to begin in early 2020, but the results provide proof-of-concept that B-cell depletion provides added value to the management of patients with proliferative lupus nephritis.”
Several authors disclosed financial ties to Genentech, which manufactures obinutuzumab, as well as F. Hoffmann-La Roche.
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