Unmet Needs in the Treatment of Certain Glomerular Diseases

by Lauren Taylor from In The Cloud Copy

Nephrologists worldwide have shown that there is a huge unmet need when it comes to the treatment of various glomerular diseases, in particular IgA nephropathy, focal segmental glomerulosclerosis (FSGS), and lupus nephritis. These diseases are also some of the most difficult to treat and manage. Nephrologists estimate that approximately 91% of their patients with FSGS, 81% of patients with IgA nephropathy, and 77% of lupus nephritis patients are not managed properly. This is a huge unmet need that pharmaceutical companies are trying to fill.

FSGS is a condition in which there is scarring or sclerosis on the filtering units or glomeruli of the kidneys. The glomeruli are the part of the kidney that filter waste from the blood. This scarring can lead to kidney failure, which may ultimately lead to the need for dialysis and/or a kidney transplant. Lupus nephritis is a complication of the disease systemic lupus erythematosus, commonly known as lupus. In lupus nephritis, the lupus antibodies attack the kidneys leading to kidney inflammation and the inability for kidneys to function optimally. IgA nephropathy is a condition in which the antibody immunoglobulin A (IgA) builds up in the kidneys resulting in inflammation in the kidneys that hinder the ability of them to filter waste from the body. All of these conditions result in the kidneys not functioning properly and not filtering the waste products from the blood.

Looking Toward New Treatment Options

Researchers are looking toward new treatment options to provide these patients with better outcomes. Nephrologists that treat patients with FSGS predict that approximately one-third of their patients continue to have relapses, often multiple, despite being on treatment. This highlights the critical need for better treatment options. Some new treatment options that are being highlighted include Retrophin, Reata, Complexa, and Astellas/Kyowa Kirin, among others.

Frustrations with treatment of IgA nephropathy include patients that are currently treated with ARBs and ACE inhibitors but continue to advance in their disease. If they advance, steroids are typically prescribed, but these come with their own side effects and are often not well tolerated. If steroids are not a viable option, then providers are sometimes unsure where to go next in treatment. Nephrologists desire to have a treatment for these patients that would slow the chronic kidney disease (CKD) progression and reduce the significant proteinuria that these patients experience while ultimately addressing the underlying source of the disease. Nephrologists indicate their preferred new medications for treatment include bardoxolone methyl, sparsentan, atacicept, and Nefecon.

Lupus nephritis has very high unmet needs as far as new treatment options. Currently, maintenance therapies include mycophenylate mofetil (MMF), steroids, and hydroxychloroquine, but there is a large gap in new treatment options. The lack of new treatments leaves a large unmet need. Providers stress a need for a treatment that strongly reduces the frequency of flares and severity in these patients.

Nephrologists stress the importance of new treatment options that have few severe side effects but are overall effective in stopping the disease process in the glomerular diseases. Unfortunately, the patient population with these diseases tend to be younger, so having treatment options that can help them in the long run would be of tremendous benefit.

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