ASN 2017: Richard Glassock Blog

Written by Meguid El Nahas on Sunday, 05 November 2017. Posted in OLA Blog

ASN 2017: Richard Glassock Blog

It is impossible to capture the "leading news" from the ASN meeting -  it is simply too immense-

In my field of glomerular disease, I would gave to pick out the CARDINAL and MENTOR trial findings

CARDINAL is a randomized placebo controlled study of the effects of Bardoxolone  methyl on GFR and profession of CKD in patients with Alport syndrome.  This agent was demonstrated to significantly increase GFR on a sustained basis.  Adverse events were minimal.  We do not know yet if it will prevent or delay ESRD.

MENTOR is a randomized controlled comparison study of Rituximab vs Cyclosporine A in patients with Nephrotic Syndrome due to presumed Primary Membranous Nephropathy (MN). At 24 months (12 months after stopping CsA) Rituximab therapy was non-inferior ( and likely to be greatly superior) to CsA therapy in terms of sustained complete or partial remission.  We will have to wait for an analysis of the impact of PLA2R antibody levels on these outcomes- but Rituximab has been elevated in the hierarchy of drugs used for treatment of MN as a consequence of this well designed and conducted study.

Richard Glassock

Meguid El Nahas

Professor Meguid El Nahas PhD, FRCP

Chief Editor, OLA Director

Professor El Nahas was born in Cairo, Egypt and undertook his undergraduate medical education in...
Posted: 2 months 1 week ago by elnahas #21617
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Bardoxolone has been shown to be toxic in the BEAM and BEACON studies with weight loss and potential tubular effects.
Has GFR been measured? or does the study rely on eGFR ; that unreliable surrogate of mGFR influenced by changes of serum creatinine of various aetiology.
Posted: 2 months 1 week ago by elnahas #21618
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It is very clear from measured GFR data (Inulin Clearance ) that BDX increases GFR and no nephrotoxic effects have so far been encountered in the Alport Cohort. The rise in GFR is sustained and hypertension does not develop.

Richard
Posted: 2 months 1 week ago by DJAG59 #21619
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I am intruiged - why Alport's? Is this because of the issues (weight gain / fluid retention) seen in patients with DM/heartfailure etc etc in CKD stage 4 (Beam, Beacon)?? The younger much fitter Alport's patients would be much less likely to succumb to these complications. But, if Alport's why not ADPKD, or fibrillary Gn, etc etc etc - is there a real mechanistic rationale, or is this desperately casting around for something to use it in??
Posted: 2 months 1 week ago by DJAG59 #21620
DJAG59's Avatar
I am intriuged - why Alport's? Is this because of the issues (weight gain / fluid retention) seen in patients with DM/heartfailure etc etc in CKD stage 4 (Beam, Beacon)?? The younger much fitter Alport's patients would be much less likely to succumb to these complications. But, if Alport's why not ADPKD, or fibrillary Gn, etc etc etc - is there a real mechanistic rationale, or is this desperately casting around for something to use it in??
Posted: 2 months 1 week ago by tukaram #21621
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Choice of CNI (and not first line CYP) as a comparator to Rituximab in MENTOR is surprisingly.

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