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2017 ; 2
(4
): 654-664
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gab.com Text
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English Wikipedia
Efficacy and Safety of Sparsentan Compared With Irbesartan in Patients With
Primary Focal Segmental Glomerulosclerosis: Randomized, Controlled Trial Design
(DUET)
#MMPMID29142983
Komers R
; Gipson DS
; Nelson P
; Adler S
; Srivastava T
; Derebail VK
; Meyers KE
; Pergola P
; MacNally ME
; Hunt JL
; Shih A
; Trachtman H
Kidney Int Rep
2017[Jul]; 2
(4
): 654-664
PMID29142983
show ga
INTRODUCTION: Primary focal segmental glomerulosclerosis (FSGS) is a leading
cause of nephrotic syndrome and end-stage renal disease. There are no US Food and
Drug Administration-approved therapies for FSGS, and treatment often fails to
reduce proteinuria. Endothelin is an important factor in the pathophysiology of
podocyte disorders, including FSGS. Sparsentan is a first-in-class, orally
active, dual-acting angiotensin receptor blocker (ARB) and highly selective
endothelin Type A receptor antagonist. This study is designed to evaluate whether
sparsentan lowers proteinuria compared with an ARB alone and has a favorable
safety profile in patients with FSGS. METHODS: DUET is a phase 2, randomized,
active-control, dose-escalation study with an 8-week, fixed-dose, double-blind
period followed by 136 weeks of open-label sparsentan treatment. Patients aged
8 to 75 years with primary FSGS will be randomized to treatment with sparsentan
or irbesartan for 8 weeks. RESULTS: The primary efficacy objective is to test the
hypothesis that sparsentan over the dose range (200 mg, 400 mg, or 800 mg daily)
is superior to irbesartan (300 mg daily) in decreasing the urinary
protein-to-creatinine ratio (UPC) from baseline to 8 weeks postrandomization. As
secondary objectives, the trial will evaluate the proportion of patients who
achieve prespecified targets of UPC reduction, changes in laboratory and
quality-of-life indices, and detailed safety analysis. Analyses will be conducted
at the end of the double-blind (week 8) and open-label (week 144) periods.
DISCUSSION: This study will provide important evidence on whether dual ARB and
endothelin blockade may be an effective therapeutic strategy for FSGS and may
provide the rationale for next-phase trials.