Eprodisate for the treatment of renal disease in AA amyloidosis.

Abstract

BACKGROUND:

Amyloid A (AA) amyloidosis is a complication of chronic inflammatory conditions that develops when proteolytic fragments of serum amyloid A protein (SAA) are deposited in tissues as amyloid fibrils. Amyloid deposition in the kidney causes progressive deterioration in renal function. Eprodisate is a member of a new class of compounds designed to interfere with interactions between amyloidogenic proteins and glycosaminoglycans and thereby inhibit polymerization of amyloid fibrils and deposition of the fibrils in tissues.

METHODS:

We performed a multicenter, randomized, double-blind, placebo-controlled trial to evaluate the efficacy and safety of eprodisate in patients with AA amyloidosis and kidney involvement. We randomly assigned 183 patients from 27 centers to receive eprodisate or placebo for 24 months. The primary composite end point was an assessment of renal function or death. Disease was classified as worsened if any one of the following occurred: doubling of the serum creatinine level, reduction in creatinine clearance by 50% or more, progression to end-stage renal disease, or death.

RESULTS:

At 24 months, disease was worsened in 24 of 89 patients who received eprodisate (27%) and 38 of 94 patients given placebo (40%, P=0.06); the hazard ratio for worsening disease with eprodisate treatment was 0.58 (95% confidence interval, 0.37 to 0.93; P=0.02). The mean rates of decline in creatinine clearance were 10.9 and 15.6 ml per minute per 1.73 m(2) of body-surface area per year in the eprodisate and the placebo groups, respectively (P=0.02). The drug had no significant effect on progression to end-stage renal disease (hazard ratio, 0.54; P=0.20) or risk of death (hazard ratio, 0.95; P=0.94). The incidence of adverse events was similar in the two groups.

CONCLUSIONS:

Eprodisate slows the decline of renal function in AA amyloidosis. (ClinicalTrials.gov number, NCT00035334.)

• Authors: Laura M Dember, Philip N Hawkins, Bouke P C Hazenberg, Peter D Gorevic, Giampaolo Merlini, Irena Butrimiene, Avi Livneh, Olga Lesnyak, Xavier Puéchal, Helen J Lachmann, Laura Obici, Robert Balshaw, Denis Garceau, Wendy Hauck, Martha Skinner, Eprodisate for AA Amyloidosis Trial Group
• Journal: The New England journal of medicine (N Engl J Med) Vol. 356 Issue 23 Pg. 2349-60 (Jun 07 2007) ISSN: 1533-4406 [Electronic] United States
• PMID: 17554116 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
• Copyright: Copyright 2007 Massachusetts Medical Society.

Chemical References

• Glycosaminoglycans
• Serum Amyloid A Protein
• Sulfonic Acids
• eprodisate
• Creatinine
• Propane

Topics

• Amyloidosis (drug therapy, etiology, mortality)
• Arthritis, Rheumatoid (complications)
• Creatinine (blood)
• Disease Progression
• Double-Blind Method
• Familial Mediterranean Fever (complications)
• Female
• Glycosaminoglycans (antagonists & inhibitors)
• Humans
• Kaplan-Meier Estimate
• Kidney Diseases (drug therapy, etiology, mortality)
• Kidney Failure, Chronic (prevention & control)
• Male
• Middle Aged
• Propane (adverse effects, analogs & derivatives, therapeutic use)
• Proportional Hazards Models
• Proteinuria
• Serum Amyloid A Protein (drug effects)
• Sulfonic Acids (adverse effects, therapeutic use)