Emerging treatments

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Chronisch nierlijden (multidisciplinaire aanpak)Published by: WORELLast published: 2017GPC pluridisciplinaire sur la néphropathie chronique (IRC)Published by: Groupe de travail Développement de recommandations de première ligneLast published: 2017

Roxadustat

Roxadustat is an oral inhibitor of hypoxia-inducible factor (HIF) prolyl hydroxylase that stimulates erythropoiesis and regulates iron metabolism. It shows promise as an alternative to epoetin alfa as a therapy for anemia in patients with CKD. It is currently in phase 3 clinical trials.[132][133] One meta-analysis of existing phase 2 and phase 3 trials concluded that hemoglobin levels increased in patients with CKD who were not on dialysis and hemoglobin levels were maintained in those patients requiring dialysis.[134] The European Medicines Agency has approved the use of roxadustat for the treatment of adults with symptomatic anemia associated with CKD. The Food and Drug Administration has requested further trials on the safety of roxadustat in both nondialysis-dependent and dialysis-dependent patient populations.

Daprodustat

Daprodustat is an oral inhibitor of HIF prolyl-hydroxylase. In phase 3 trials of patients with CKD (not undergoing dialysis and undergoing dialysis) and anemia, it was shown to be noninferior to erythropoiesis-stimulating agents for change in the hemoglobin level from baseline and major cardiovascular adverse events.[135][136] Daprodustat is currently approved for use in Japan.

Veverimer

Veverimer is a nonabsorbed polymer which selectively binds and removes hydrochloric acid from the gastrointestinal lumen and is being investigated for the treatment of metabolic acidosis in patients with CKD. It has been shown to significantly increase serum bicarbonate concentration, with minimal adverse effects. The Food and Drug Administration is currently reviewing an application for approval.[137][138]

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