Abstract | BACKGROUND: METHODS: In this double-blind, randomized, placebo-controlled trial, patients were on the maximum tolerated dose of either an Ang II receptor blocker or an Ang-converting enzyme inhibitor since at least 3 months before the screening visit. Eligible patients were randomized in a 2:1 ratio to treatment with either 25 mg fulacimstat (n = 99) or placebo (n = 48) twice daily on top of standard of care. RESULTS: The randomized patients had a mean urine albumin- creatinine ratio (UACR) of 131 mg/g (range: 29-2429 mg) and a mean (standard deviation) estimated glomerular filtration rate of 60.8 ± 16.9 mL/min/1.73 m2 before treatment start. Fulacimstat was safe and well tolerated, and achieved mean total trough concentrations that were ∼9-fold higher than those predicted to be required for minimal therapeutic activity. UACR increased by 27.4% [coefficient of variation (CV) 86%] and 3% (CV 88.9%) after 24 weeks of treatment with placebo or fulacimstat, respectively. Analysis of covariance revealed a least square mean UACR ratio ( fulacimstat/placebo) of 0.804 (90% CI 0.627-1.030, P = 0.1477), indicating a statistically non-significant UACR reduction of 19.6% after fulacimstat treatment compared with placebo. CONCLUSIONS:
Fulacimstat was safe and well tolerated but did not reduce albuminuria in patients with DKD. These findings do not support a therapeutic role for chymase inhibition in DKD.
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Authors | Peter Rossing, Jorma Strand, Angelo Avogaro, Michael Becka, Friederike Kanefendt, Christiane Otto |
Journal | Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
(Nephrol Dial Transplant)
Vol. 36
Issue 12
Pg. 2263-2273
(12 02 2021)
ISSN: 1460-2385 [Electronic] England |
PMID | 33367744
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | © The Author(s) 2020. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. |
Chemical References |
- Carboxylic Acids
- Indenes
- Pyrimidines
- Chymases
- fulacimstat
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Topics |
- Albuminuria
(drug therapy, etiology)
- Carboxylic Acids
- Chymases
- Diabetes Mellitus, Type 2
(complications, drug therapy)
- Diabetic Nephropathies
(drug therapy, etiology)
- Double-Blind Method
- Glomerular Filtration Rate
- Humans
- Indenes
- Pyrimidines
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