Kidney disease is a key issue in the global medical community because it can progress to end-stage renal disease, i.e., uremia. Even if the disease is controlled, the quality of life and longevity of patients are greatly affected.
LGA nephropathyYesThe type of kidney disease with the largest number of people and the greatest impact in China is about one in every 2 to 3 peopleLGA nephropathypatients
The disease was discovered more than 50 years ago and is the most common primary glomerular disease in the world, and the patient population develops rapidly, mainly in young adults, ** is not fully understood, but has become the first cause of chronic kidney disease and kidney failure.
LGA nephropathy can not be completely ** at present, and there is no special symptomatic drug, its refractory nature lies in the number of ** kidney disease, and there are 3 popular understandings:
lgaLike the "guard" of the human body, it looks like two sharpened toothpicksIt travels through the blood, protects cell safety, stabs invading pathogens, and also participates in the metabolism of the human liver and kidneys, which plays an important role.
But some people LGA is different, the mutation in young adults is as big as chopsticks, and it is fine in the liver, but when it comes to the kidneys, it is stuck, the kidneys cannot be discharged, and the glomeruli is punctured, and a large amount of urine protein is lost, which induces inflammatory reactions.
2. LGA nephropathy can cause hematuria, proteinuria, hypertension and impaired kidney function, especially severe damage to urine protein。However, most patients have no symptoms, and only physical examinations are shocked, when in fact, the kidneys have already been damaged and directly enter the stage of kidney failure.
3. Even if it is discovered, LGA nephropathy will continue to progressOn the one hand, the support is not done well, and the degree of relevant drugs to reduce urine protein is low, which does not meet the requirements. On the other hand, there are more LGAs, and the important ones are angiotensin, endothelin, etc., which are difficult to deal with with a single drug.
Before 2023, there are 2 drugs for LGA nephropathy in the medical community:
One is emergency medicine, using the means of controlling blood pressure to reduce urine protein damage, indirectly alleviate the effects of LGA nephropathy, the drug is antihypertensive drugs, containing angiotensin inhibitors, angiotensin receptor antagonists, that is, pril sartan drugs.
The second is a special drugEarlier, glucocorticoids were used, but it was not small, and then the first special drug appeared: budesonide targeted sustained-release agent, urine protein decreased by about 30%, * less, but the overall effectiveness and early hormones are about the same, the key is very expensive, and the price in China is as high as 200,000 yuan a year.
In February 2023, the US FDA accelerated the approval of the second LGA nephropathy drug for the market, which lifted the spirit of the industry. This drug is called spasentan (sparsentan) and is manufactured by Gilead in the United States
Sparsentan was originally developed as a new generation of hypertension monotherapy, after all, since 2000, there has been no new monotherapy for hypertension in the world. But around 2018, researchers found that in addition to sniping angiotensin, the cause of kidney injury, it can also snipe endothelin, which is a multi-purpose drug.
The researchers tried to use spasentan** for segmental glomerulosclerosis, and the success means that it should be used against LGA nephropathy. The clinical trial was conducted immediately, and interim results from the Phase 3 clinical trial were announced in 2021.
With the use of sartans (irbesartan), the urine protein is reduced by 151%, with sparsentan, urine protein reduction reached 498%, sparsentan is more than 3 times more effective than the control group
This means that spasentan is likely to be the drug of choice for LGA nephropathy, and the data is outstanding, the efficacy is certain, and if there is no extranephant, it will be approved for marketing soon.
In May 2022, The Lancet announced the final results of the phase 3 clinical trial of sparsentan, in which 404 patients with LGA nephropathy volunteered for 9 months with a median urine protein of 18 grams, the result is still the same, the urine protein is reduced by more than 3 times,** comparable to sartans
Clinical trials have confirmed that the sparsentam-pisartan **LGA nephropathy is much more effective, but what about the targeted extended-release budesonide compared to budesonide
The safety of budesonide targeted sustained-release agent has been improved, and the effectiveness has basically not changed;Sparsentan has maintained the same safety profile but significantly improved efficacy, so it has replaced budesonide as the preferred drug for LGA nephropathy.
Is it possible to reverse kidney disease and cure it completely?Not at the moment. Because the cause of LGA nephropathy is not fully understood, spasentan can only be said to support **, delay kidney failure, and buy time for patients。And there are 3 things to be aware of with the drug:
1. It is preferentially used for patients with rapid progression of LGA nephropathy, and the urine protein is greater than 15 grams, so urine protein 0Patients with less than 5 grams have mild disease and are not eligible for use.
2. ** It is equivalent to sartan drugs, including edema, dizziness, hypotension, hyperkalemia, anemia, etc., and it is necessary to strictly follow the doctor's instructions.
3. The drug is still not listed in China, it can only be overseas, and the risk is not small, there are generic drugs in India, but the efficacy is unknown.
The list of high-quality authors is more concerned about the **, the specification of Sparsentan 400mgx30 tablets, one bottle per month, and the price in the United States is 1 per bottle040,000 US dollars, with an annual cost of more than 120,000 US dollars, equivalent to more than 840,000 yuan. Few patients in China can afford to eat. If it is listed in China and enters the medical insurance in the future, it will be good news. However, if patients can't afford to wait, the current best means in China are the combination of three drugs: that is, sartan pril, declarinal drugs, and traditional Chinese medicine, which can be used as first-line drugs.