Atrasentan Reduces Proteinuria in IgA Nephropathy Patients in New Trial Findings

A study published in the New England Journal of Medicine and presented at the American Society of Nephrology’s Kidney Week indicates that atrasentan, a selective endothelin type A receptor antagonist, significantly reduces proteinuria in patients with immunoglobulin A (IgA) nephropathy. This chronic kidney disease is associated with progressive renal damage and has limited treatment options, highlighting atrasentan’s potential clinical relevance.

Led by Hiddo J. L. Heerspink, Ph.D., of the University of Groningen, the study evaluated atrasentan’s efficacy and safety in a double-blind trial involving 270 patients with IgA nephropathy. Participants were randomized to receive either atrasentan (0.75 mg daily) or a placebo over a 132-week period, providing a comprehensive assessment of its impact on proteinuria over an extended timeframe.

Interim results from the study showed that patients treated with atrasentan had a notable reduction in proteinuria. Specifically, those on atrasentan experienced a 38.1% decrease in the urinary protein-to-creatinine ratio from baseline, compared to a 3.1% reduction in the placebo group, resulting in a statistically significant 36.1 percentage-point difference.

Safety outcomes indicated that adverse events were generally similar between the two groups. Fluid retention was observed in 11.2% of patients on atrasentan and in 8.2% of those on placebo; however, this did not lead to treatment discontinuation in either group. No instances of severe edema or heart failure were reported during the trial, suggesting a manageable safety profile for atrasentan.

These findings are particularly relevant for clinicians treating IgA nephropathy, as current therapeutic options to manage proteinuria and slow disease progression remain limited. While further results from the study’s full duration will clarify atrasentan’s long-term efficacy and safety, the significant reduction in proteinuria observed in this interim analysis underscores its potential as a new option for managing IgA nephropathy in clinical practice.