{"title":"斯帕生坦:减少 IgA 肾病蛋白尿的第一种也是唯一一种非免疫抑制疗法。","authors":"Howard Trachtman, Radko Komers, Jula Inrig","doi":"10.1080/1744666X.2024.2319132","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>IgA nephropathy is one of the most common forms of glomerular disease. Patients with persistent proteinuria are at increased risk of progression to kidney failure. There is a significant need for safe and effective therapies to lower proteinuria in these patients. Sparsentan is a non-immunosuppressive agent that acts as a dual angiotensin and endothelin receptor antagonist. It lowers proteinuria in experimental models of glomerular disease and in affected patients.</p><p><strong>Areas covered: </strong>This review covers the immunological and non-immunological actions of sparsentan in glomerular disease. It reviews the clinical trials that evaluated the impact of the drug in pediatric and adult patients with IgA nephropathy. It places the use of sparsentan in an overall treatment paradigm for the full spectrum of patients with IgA nephropathy including nonspecific renoprotective agents such as inhibitors of the renin-angiotensin-aldosterone axis and SGLT2 transporter and immunosuppressive drugs. The review represents a search of the current literature about the effect of the drug on normal physiology and the pathogenesis of IgA nephropathy.</p><p><strong>Expert opinion: </strong>The safety, tolerability, and therapeutic efficacy of sparsentan have been demonstrated in long-term studies of patients with primary glomerular diseases extending over 5 years. The evidence in support of a beneficial treatment effect of sparsentan is stronger in IgAN than in FSGS. It is anticipated that sparsentan will supplant the use of ACEI or ARB as the first-line therapy to reduce proteinuria prior to the implementation of immunosuppressive agents in patients with IgA nephropathy. It may be combined with other renoprotective drugs like SGLT2 inhibitors. Practice guidelines are needed to promote safe and effective use of this new drug by nephrologists caring for patients with IgAN in all clinical settings.</p>","PeriodicalId":12175,"journal":{"name":"Expert Review of Clinical Immunology","volume":null,"pages":null},"PeriodicalIF":3.9000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Sparsentan: the first and only non-immunosuppressive therapy for the reduction of proteinuria in IgA nephropathy.\",\"authors\":\"Howard Trachtman, Radko Komers, Jula Inrig\",\"doi\":\"10.1080/1744666X.2024.2319132\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>IgA nephropathy is one of the most common forms of glomerular disease. Patients with persistent proteinuria are at increased risk of progression to kidney failure. 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引用次数: 0
摘要
简介IgA 肾病是最常见的肾小球疾病之一。持续蛋白尿患者发展为肾衰竭的风险增加。目前亟需安全有效的疗法来降低这些患者的蛋白尿。Sparsentan 是一种非免疫抑制剂,具有血管紧张素和内皮素受体双重拮抗剂的作用。它能降低肾小球疾病实验模型和受影响患者的蛋白尿:本综述涵盖了斯帕生坦在肾小球疾病中的免疫和非免疫作用。它回顾了评估该药物对儿童和成年 IgA 肾病患者影响的临床试验。它将斯帕生坦应用于 IgA 肾病患者的整体治疗模式中,包括非特异性肾保护药物,如肾素-血管紧张素-醛固酮轴抑制剂、SGLT2 转运体抑制剂和免疫抑制剂。本综述是对有关药物对正常生理和 IgA 肾病发病机制影响的现有文献的检索:斯帕生坦的安全性、耐受性和疗效已在对原发性肾小球疾病患者进行的长达 5 年以上的长期研究中得到证实。支持斯帕生坦治疗效果的证据在 IgAN 中比在 FSGS 中更强。预计斯帕生坦将取代 ACEI 或 ARB,成为 IgA 肾病患者在使用免疫抑制剂之前减少蛋白尿的一线疗法。它可与其他肾脏保护药物(如 SGLT2i)联合使用。需要制定实践指南,以促进肾科医生在所有临床环境中安全、有效地使用这种新药来治疗 IgAN 患者。
Sparsentan: the first and only non-immunosuppressive therapy for the reduction of proteinuria in IgA nephropathy.
Introduction: IgA nephropathy is one of the most common forms of glomerular disease. Patients with persistent proteinuria are at increased risk of progression to kidney failure. There is a significant need for safe and effective therapies to lower proteinuria in these patients. Sparsentan is a non-immunosuppressive agent that acts as a dual angiotensin and endothelin receptor antagonist. It lowers proteinuria in experimental models of glomerular disease and in affected patients.
Areas covered: This review covers the immunological and non-immunological actions of sparsentan in glomerular disease. It reviews the clinical trials that evaluated the impact of the drug in pediatric and adult patients with IgA nephropathy. It places the use of sparsentan in an overall treatment paradigm for the full spectrum of patients with IgA nephropathy including nonspecific renoprotective agents such as inhibitors of the renin-angiotensin-aldosterone axis and SGLT2 transporter and immunosuppressive drugs. The review represents a search of the current literature about the effect of the drug on normal physiology and the pathogenesis of IgA nephropathy.
Expert opinion: The safety, tolerability, and therapeutic efficacy of sparsentan have been demonstrated in long-term studies of patients with primary glomerular diseases extending over 5 years. The evidence in support of a beneficial treatment effect of sparsentan is stronger in IgAN than in FSGS. It is anticipated that sparsentan will supplant the use of ACEI or ARB as the first-line therapy to reduce proteinuria prior to the implementation of immunosuppressive agents in patients with IgA nephropathy. It may be combined with other renoprotective drugs like SGLT2 inhibitors. Practice guidelines are needed to promote safe and effective use of this new drug by nephrologists caring for patients with IgAN in all clinical settings.
期刊介绍:
Expert Review of Clinical Immunology (ISSN 1744-666X) provides expert analysis and commentary regarding the performance of new therapeutic and diagnostic modalities in clinical immunology. Members of the International Editorial Advisory Panel of Expert Review of Clinical Immunology are the forefront of their area of expertise. This panel works with our dedicated editorial team to identify the most important and topical review themes and the corresponding expert(s) most appropriate to provide commentary and analysis. All articles are subject to rigorous peer-review, and the finished reviews provide an essential contribution to decision-making in clinical immunology.
Articles focus on the following key areas:
• Therapeutic overviews of specific immunologic disorders highlighting optimal therapy and prospects for new medicines
• Performance and benefits of newly approved therapeutic agents
• New diagnostic approaches
• Screening and patient stratification
• Pharmacoeconomic studies
• New therapeutic indications for existing therapies
• Adverse effects, occurrence and reduction
• Prospects for medicines in late-stage trials approaching regulatory approval
• Novel treatment strategies
• Epidemiological studies
• Commentary and comparison of treatment guidelines
Topics include infection and immunity, inflammation, host defense mechanisms, congenital and acquired immunodeficiencies, anaphylaxis and allergy, systemic immune diseases, organ-specific inflammatory diseases, transplantation immunology, endocrinology and diabetes, cancer immunology, neuroimmunology and hematological diseases.