Journal
EXPERT OPINION ON INVESTIGATIONAL DRUGS
Volume 26, Issue 6, Pages 741-750Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1080/13543784.2017.1325872
Keywords
Endothelin 1; endothelin receptor antagonists; diabetic nephropathy; atrasentan; proteinuria; inflammation; fibrosis
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Funding
- FEDER-FIS Funds [PI14/00386, CP12/03262, PI14/00041]
- Spanish Ministry of Economy and Competitiveness [SAF2015-63696-R]
- [7FP 279074.EudraCT 2013-000418-39]
- [HEALTH 2011.2.4.3-1]
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Introduction: Endothelin-1 (ET-1) is the most potent vasoconstrictor, and is involved in the renal regulation of salt and water homeostasis. When produced in excess in the kidney, ET-1 promotes proteinuria and tubulointerstitial injury. There is great interest in the clinical use of endothelin receptor antagonists (ERAs) in chronic kidney disease (CKD), mainly in diabetic nephropathy (DN).Areas covered: Physiopathological actions of ET-1 on the kidney. Both dual ETAR/ETBR (bosentan) or ETAR specific endothelin antagonists (avosentan and atrasentan, among others), which have progressed to early clinical development, with particular emphasis on atrasentan.Expert opinion: Different phase I and II clinical trials with ERAs in DN, mostly with atrasentan, have shown that these drugs have a marked anti-proteinuric effect on residual proteinuria when administered as add-on therapy in addition to ACEi or ARAII treatment. In the past few years, a series of randomized controlled trials investigating new approaches to DN have provided negative or inconclusive data, or even were terminated due to safety concerns or lack of efficacy. Therefore, we eagerly but cautiously await the results of the ongoing SONAR trial with atrasentan in more than 4,000 patients including assessment of renal and cardiovascular hard-end points (estimated primary completion date, July 2018).
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