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Sparsentan in patients with IgA nephropathy: a prespecified interim analysis from a randomised, double-blind, active-controlled clinical trial

Heerspink, Hiddo J L ; Wong, Muh Geot ; Perkovic, Vlado ; Del Vecchio, Lucia ; Nolasco, Fernando Eduardo Barbosa ; Praga, Manual ; Rabindranath, Kannaiyan ; Wong, Muh Geot ; Yeap, Chii ; Clayton, Philip ; Coates, Toby ; Waugh, Jane ; Noble, Euan ; Wan, Susan ; Foote, Celine ; Endre, Zoltan ; Wijeratne, Vidu ; Ombelet, Sara ; Warling, Xavier ; Barisic, Dunja ; Drinkovic, Martin ; Masson, Ingrid ; Dinic, Miriana ; Fouassier, David ; Karras, Alexandre ; Delmas, Yahsou ; Rigothier, Claire ; de Précigout, Valérie ; Draganova, Diliana ; Heinrichs, Sven ; Kulka, Simone ; Sarnow, Franziska ; Stamellou, Eleni ; Sanden, Silja ; Patecki, Margret ; Girardet, Annette ; Kunzendorf, Ulrich ; Mok, Maggie Ming Yee ; Szeto, Cheuk Chun ; Fung, Ka Shun Samuel ; Yim, Ka Fai ; Wong, Sze Ho Sunny ; Cogno, Chiara ; Zizzi, Carlotta Federica ; Napodano, Pietro ; Accarino, Simone ; Urciuolo, Federica ; Bumblyte', Inga Arune ; Pilmore, Helen ; Manley, Paul ; Goh, Tze ; Ahmed, Jafar ; Jander, Anna ; Sulowicz, Wladyslaw ; Raimundo, Mario ; Nolasco, Fernando ; Menezes, Maria ; Cardoso, Filipa ; Barata, Rui ; Oh, Kook-Hwan ; Lee, Kyu-Beck ; Lee, Hyung-seok ; Jo, Sang-Kyung ; Oh, SeWon ; Gimeno, Ana Vilar ; Tamarit, Esther ; Verde Moreno, Eduardo ; Verdalles Guzman, Ursula ; Prado, Raul Fernandez ; Arias, Carlos ; Allende Burgos, Natalia ; Gutierrez Solis, Elena ; Rodas Marin, Lida Maria ; Garcia Carro, Clara ; Alonso Garcia, Fabiola ; Velo Plaza, Mercedes ; Moreno, Antolina ; Wang, Chih-Hsien ; Chen, Chien-Liang ; Dasgupta, Indranil ; Hamilton, Patrick ; Al Chalabi, Saif ; DaSilva, Louise ; Henderson, Amy ; Keller, Christopher ; Kattamanchi, Siddhartha ; Gautam, Archana ; Daneshvari, Sam ; Lagatta, Mark ; Ahmad, Syeda ; Canetta, Pietro ; Negrea, Lavinia ; Lifland, Howard ; Green, Heather ; Rizk, Dana ; Garg, Gunjan ; Mandayam, Sreedhar ; Workeneh, Biruh ; Assefi, Ali ; Sullivan, James

The Lancet (British edition), 2023-05, Vol.401 (10388), p.1584-1594 [Periódico revisado por pares]

England: Elsevier Ltd

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Título:
Sparsentan in patients with IgA nephropathy: a prespecified interim analysis from a randomised, double-blind, active-controlled clinical trial
Autor: Heerspink, Hiddo J L ; Wong, Muh Geot ; Perkovic, Vlado ; Del Vecchio, Lucia ; Nolasco, Fernando Eduardo Barbosa ; Praga, Manual ; Rabindranath, Kannaiyan ; Wong, Muh Geot ; Yeap, Chii ; Clayton, Philip ; Coates, Toby ; Waugh, Jane ; Noble, Euan ; Wan, Susan ; Foote, Celine ; Endre, Zoltan ; Wijeratne, Vidu ; Ombelet, Sara ; Warling, Xavier ; Barisic, Dunja ; Drinkovic, Martin ; Masson, Ingrid ; Dinic, Miriana ; Fouassier, David ; Karras, Alexandre ; Delmas, Yahsou ; Rigothier, Claire ; de Précigout, Valérie ; Draganova, Diliana ; Heinrichs, Sven ; Kulka, Simone ; Sarnow, Franziska ; Stamellou, Eleni ; Sanden, Silja ; Patecki, Margret ; Girardet, Annette ; Kunzendorf, Ulrich ; Mok, Maggie Ming Yee ; Szeto, Cheuk Chun ; Fung, Ka Shun Samuel ; Yim, Ka Fai ; Wong, Sze Ho Sunny ; Cogno, Chiara ; Zizzi, Carlotta Federica ; Napodano, Pietro ; Accarino, Simone ; Urciuolo, Federica ; Bumblyte', Inga Arune ; Pilmore, Helen ; Manley, Paul ; Goh, Tze ; Ahmed, Jafar ; Jander, Anna ; Sulowicz, Wladyslaw ; Raimundo, Mario ; Nolasco, Fernando ; Menezes, Maria ; Cardoso, Filipa ; Barata, Rui ; Oh, Kook-Hwan ; Lee, Kyu-Beck ; Lee, Hyung-seok ; Jo, Sang-Kyung ; Oh, SeWon ; Gimeno, Ana Vilar ; Tamarit, Esther ; Verde Moreno, Eduardo ; Verdalles Guzman, Ursula ; Prado, Raul Fernandez ; Arias, Carlos ; Allende Burgos, Natalia ; Gutierrez Solis, Elena ; Rodas Marin, Lida Maria ; Garcia Carro, Clara ; Alonso Garcia, Fabiola ; Velo Plaza, Mercedes ; Moreno, Antolina ; Wang, Chih-Hsien ; Chen, Chien-Liang ; Dasgupta, Indranil ; Hamilton, Patrick ; Al Chalabi, Saif ; DaSilva, Louise ; Henderson, Amy ; Keller, Christopher ; Kattamanchi, Siddhartha ; Gautam, Archana ; Daneshvari, Sam ; Lagatta, Mark ; Ahmad, Syeda ; Canetta, Pietro ; Negrea, Lavinia ; Lifland, Howard ; Green, Heather ; Rizk, Dana ; Garg, Gunjan ; Mandayam, Sreedhar ; Workeneh, Biruh ; Assefi, Ali ; Sullivan, James
Assuntos: Active control ; Adolescent ; Adult ; Adults ; Angiotensin ; Biopsy ; Blood pressure ; Clinical medicine ; Clinical trials ; Congestive heart failure ; Creatinine ; Creatinine - urine ; Diabetes ; Double-Blind Method ; Double-blind studies ; Drug dosages ; Edema ; Effectiveness ; Endocrine system ; Endothelins ; FDA approval ; Glomerular filtration rate ; Glomerulonephritis, IGA - drug therapy ; Hepatotoxicity ; Humans ; IgA nephropathy ; Immunoglobulin A ; Immunoglobulins ; Irbesartan - therapeutic use ; Kidney diseases ; Least squares ; Pathophysiology ; Patients ; Proteins ; Proteinuria ; Proteinuria - drug therapy ; Reduction ; Remission (Medicine) ; Renin ; Safety ; Treatment Outcome ; Urine
É parte de: The Lancet (British edition), 2023-05, Vol.401 (10388), p.1584-1594
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
ObjectType-Undefined-3
Descrição: Sparsentan is a novel, non-immunosuppressive, single-molecule, dual endothelin and angiotensin receptor antagonist being examined in an ongoing phase 3 trial in adults with IgA nephropathy. We report the prespecified interim analysis of the primary proteinuria efficacy endpoint, and safety. PROTECT is an international, randomised, double-blind, active-controlled study, being conducted in 134 clinical practice sites in 18 countries. The study examines sparsentan versus irbesartan in adults (aged ≥18 years) with biopsy-proven IgA nephropathy and proteinuria of 1·0 g/day or higher despite maximised renin-angiotensin system inhibitor treatment for at least 12 weeks. Participants were randomly assigned in a 1:1 ratio to receive sparsentan 400 mg once daily or irbesartan 300 mg once daily, stratified by estimated glomerular filtration rate at screening (30 to <60 mL/min per 1·73 m2 and ≥60 mL/min per 1·73 m2) and urine protein excretion at screening (≤1·75 g/day and >1·75 g/day). The primary efficacy endpoint was change from baseline to week 36 in urine protein–creatinine ratio based on a 24-h urine sample, assessed using mixed model repeated measures. Treatment-emergent adverse events (TEAEs) were safety endpoints. All endpoints were examined in all participants who received at least one dose of randomised treatment. The study is ongoing and is registered with ClinicalTrials.gov, NCT03762850. Between Dec 20, 2018, and May 26, 2021, 404 participants were randomly assigned to sparsentan (n=202) or irbesartan (n=202) and received treatment. At week 36, the geometric least squares mean percent change from baseline in urine protein–creatinine ratio was statistically significantly greater in the sparsentan group (–49·8%) than the irbesartan group (–15·1%), resulting in a between-group relative reduction of 41% (least squares mean ratio=0·59; 95% CI 0·51–0·69; p<0·0001). TEAEs with sparsentan were similar to irbesartan. There were no cases of severe oedema, heart failure, hepatotoxicity, or oedema-related discontinuations. Bodyweight changes from baseline were not different between the sparsentan and irbesartan groups. Once-daily treatment with sparsentan produced meaningful reduction in proteinuria compared with irbesartan in adults with IgA nephropathy. Safety of sparsentan was similar to irbesartan. Future analyses after completion of the 2-year double-blind period will show whether these beneficial effects translate into a long-term nephroprotective potential of sparsentan. Travere Therapeutics.
Editor: England: Elsevier Ltd
Idioma: Inglês

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Sparsentan in patients with IgA nephropathy: a prespecified interim analysis from a randomised, double-blind, active-controlled clinical trial

England: Elsevier Ltd

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