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Clinical Research
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The Endothelin Antagonist Atrasentan Lowers Residual Albuminuria in Patients with Type 2 Diabetic Nephropathy

Dick de Zeeuw, Blai Coll, Dennis Andress, John J. Brennan, Hui Tang, Mark Houser, Ricardo Correa-Rotter, Donald Kohan, Hiddo J. Lambers Heerspink, Hirofumi Makino, Vlado Perkovic, Yili Pritchett, Giuseppe Remuzzi, Sheldon W. Tobe, Robert Toto, Giancarlo Viberti and Hans-Henrik Parving
JASN May 2014, 25 (5) 1083-1093; DOI: https://doi.org/10.1681/ASN.2013080830
Dick de Zeeuw
*Department of Clinical Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;
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Blai Coll
†Renal Clinical Development and
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Dennis Andress
†Renal Clinical Development and
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John J. Brennan
†Renal Clinical Development and
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Hui Tang
‡Data and Statistical Sciences, AbbVie, North Chicago, Illinois;
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Mark Houser
†Renal Clinical Development and
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Ricardo Correa-Rotter
§Salvador Zubiran National Medical Science and Nutrition Institute, Mexico City, Mexico;
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Donald Kohan
‖Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, Utah;
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Hiddo J. Lambers Heerspink
*Department of Clinical Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;
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Hirofumi Makino
¶Okayama University Graduate School of Medicine, Okayama, Japan;
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Vlado Perkovic
**George Institute for Global Health, University of Sydney, Sydney, Australia;
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Yili Pritchett
††Astellas Global Pharma Development, Inc., Northbrook, Illinois;
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Giuseppe Remuzzi
‡‡Azienda Ospedaliera Papa Giovanni XXIII and IRCCS-Instituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy;
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Sheldon W. Tobe
§§Sunnybrook Health Sciences Center, Toronto, Ontario, Canada;
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Robert Toto
‖‖University of Texas Southwestern Medical Center, Dallas, Texas;
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Giancarlo Viberti
¶¶Kings’ College London School of Medicine, London, United Kingdom; and
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Hans-Henrik Parving
***Department of Medical Endocrinology, Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark
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Abstract

Despite optimal treatment, including renin-angiotensin system (RAS) inhibitors, patients with type 2 diabetic nephropathy have high cardiorenal morbidity and mortality related to residual albuminuria. We evaluated whether or not atrasentan, a selective endothelin A receptor antagonist, further reduces albuminuria when administered concomitantly with maximum tolerated labeled doses of RAS inhibitors. We enrolled 211 patients with type 2 diabetes, urine albumin/creatinine ratios of 300–3500 mg/g, and eGFRs of 30–75 ml/min per 1.73 m2 in two identically designed, parallel, multinational, double-blind studies. Participants were randomized to placebo (n=50) or to 0.75 mg/d (n=78) or 1.25 mg/d (n=83) atrasentan for 12 weeks. Compared with placebo, 0.75 mg and 1.25 mg atrasentan reduced urine albumin/creatinine ratios by an average of 35% and 38% (95% confidence intervals of 24 to 45 and 28 to 47, respectively) and reduced albuminuria≥30% in 51% and 55% of participants, respectively. eGFR and office BP measurements did not change, whereas 24-hour systolic and diastolic BP, LDL cholesterol, and triglyceride levels decreased significantly in both treatment groups. Use of atrasentan was associated with a significant increase in weight and a reduction in hemoglobin, but rates of peripheral edema, heart failure, or other side effects did not differ between groups. However, more patients treated with 1.25 mg/d atrasentan discontinued due to adverse events. After stopping atrasentan for 30 days, measured parameters returned to pretreatment levels. In conclusion, atrasentan reduced albuminuria and improved BP and lipid spectrum with manageable fluid overload–related adverse events in patients with type 2 diabetic nephropathy receiving RAS inhibitors.

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Journal of the American Society of Nephrology: 25 (5)
Journal of the American Society of Nephrology
Vol. 25, Issue 5
May 2014
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The Endothelin Antagonist Atrasentan Lowers Residual Albuminuria in Patients with Type 2 Diabetic Nephropathy
Dick de Zeeuw, Blai Coll, Dennis Andress, John J. Brennan, Hui Tang, Mark Houser, Ricardo Correa-Rotter, Donald Kohan, Hiddo J. Lambers Heerspink, Hirofumi Makino, Vlado Perkovic, Yili Pritchett, Giuseppe Remuzzi, Sheldon W. Tobe, Robert Toto, Giancarlo Viberti, Hans-Henrik Parving
JASN May 2014, 25 (5) 1083-1093; DOI: 10.1681/ASN.2013080830

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The Endothelin Antagonist Atrasentan Lowers Residual Albuminuria in Patients with Type 2 Diabetic Nephropathy
Dick de Zeeuw, Blai Coll, Dennis Andress, John J. Brennan, Hui Tang, Mark Houser, Ricardo Correa-Rotter, Donald Kohan, Hiddo J. Lambers Heerspink, Hirofumi Makino, Vlado Perkovic, Yili Pritchett, Giuseppe Remuzzi, Sheldon W. Tobe, Robert Toto, Giancarlo Viberti, Hans-Henrik Parving
JASN May 2014, 25 (5) 1083-1093; DOI: 10.1681/ASN.2013080830
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