Diabetic Kidney Disease

Potential benefits of combination therapy

Ralph A. DeFronzo, MD, professor of medicine and chief of the diabetes division at the University of Texas Health Science Center in San Antonio, recommends triple or quadruple combination therapy for preventing complications in patients with diabetic kidney disease (DKD). In a presentation at the Heart in Diabetes conference, he stressed the need for combination therapy even at the start of treatment due to the various abnormalities that can present in the kidneys. He discussed the potential benefits of utilizing several therapies to treat and prevent complications of DKD. Any FDA-approved sodium-glucose cotransporter-2 (SGLT2) inhibitor is a useful agent for correcting multiple components of diabetic nephropathy, he noted. In combination with SGLT2 inhibitors, finerenone a nonsteroidal mineralocorticoid receptor antagonist, can help to reduce adverse outcomes despite being unable to lower glucose levels. However, DeFronzo cautioned that further research must be performed on the effectiveness of glucagon-like peptide 1 receptor agonists and renal protection. Overall, these recommendations can help decrease the correlation rate between DKD and end-stage renal disease in the US.

Source: http://www.healio.com/news/endocrinology/20210912/treatment-of-diabetic-kidney-d

LYMPHOMA

FDA approves zanubrutinib for relapsed/refractory marginal zone lymphoma

Since 2020, the MAGNOLIA trial led by principal investigator Stephen Opat, FRACP, FRCPA, MBBS, director of clinical hematology at Monash Health and department head of Hematology at Monash University, tested the use of zanubrutinib, a kinase inhibitor, in patients with relapsed/refractory marginal zone lymphoma (MZL) following prior treatment with at least one anti-CD20-based regimen. MZL is a group of slow-growing non-Hodgkin B-cell lymphomas. The developing drug zanubrutinib (Brukinsa) is a small molecule inhibitor of Bruton's tyrosine kinase (BTK) that aims to treat this rare disease.

The most commonly reported adverse reactions include neutropenia, upper respiratory tract infection, thrombocytopenia, hemorrhage, lymphocytopenia, rash, and musculoskeletal pain.

The drug was granted accelerated approval by the FDA after 85% of patients sustained remission after 12 months in the single-arm, open-label, multicenter trial. Although further approval may require a confirmatory trial, Opat praised the favorable outcomes stating, "this next-generation BTK inhibitor was well-tolerated in these patients, with a low rate of discontinuation due to adverse reactions. We are optimistic that Brukinsa will bring clinically meaningful benefit to patients with relapsed or refractory marginal zone lymphoma."

Source: http://www.cancernetwork.com/view/fda-grants-accelerated-approval-to-zanubrutini

HYPERTENSION

'Quadpill' more effective than monotherapy in lowering BP

Fixed-dose BP-lowering quadpill treatment was more effective in treating hypertension than monotherapy, found a new study published in The Lancet. The quadpill used had quarter doses of irbesartan, amlodipine, indapamide, and bisoprolol. The study findings were also presented at the European Society of Cardiology (ESC) Congress 2021 by Clara Chow, MD, PhD, the academic director of the Westmead Applied Research Centre at the University of Sydney, Australia.

This outcome is from a 1-year phase-3 QUARTET randomized, active-control trial, which found that participants who received the daily quadpill had reduced mean unattended BP at 12 weeks, from 142/86 mm Hg to 120/71 mm Hg. Comparatively, those on monotherapy-receiving a full dose of irbesartan per day-had reduced BP, from 140/83 mm Hg to 127/79 mm Hg.

At her ESC presentation, Chow also noted that at 12 months, 81% of patients who received the quadpill versus 62% of those on monotherapy had BP control (<140/90 mm Hg).

According to ESC session co-chair Thomas Kahan, MD, PhD, from the Karolinska Institute, Danderyd Hospital, Department of Clinical Sciences in Stockholm, Sweden, quadpill dosing is in line with the latest guidelines from the ESC/European Society of Hypertension, which recommends that patients with hypertension start treatment with more than one drug.

Source: http://www.medscape.com/viewarticle/958183

MIGRAINE

FDA approves new intranasal treatment

The FDA has approved the use of dihydroergotamine mesylate to treat acute migraine, with or without aura, in adults. This new treatment is a nasal spray that "bypasses the gut and potential absorption issues, offering rapid, sustained, and consistent symptom relief without injection or infusion, even when administered hours after the onset of a migraine attack," noted in a press release.

"I think patients will be very receptive to this treatment because it pairs the long-proven benefits of [dihydroergotamine] with a patient-friendly delivery system," said Stephanie J. Nahas-Geiger, MD, MSEd, the program director of the Headache Medicine Fellowship Program at Thomas Jefferson University in Philadelphia, in the release. She said that this new drug offers a fast-acting and reliable option that addresses the shortcomings of other available medications.

In a 52-week trial investigating the safety and tolerability of intranasal delivery of dihydroergotamine mesylate in patients with migraine, 38% of participants reported freedom from migraine pain, 66% reported pain relief, and 52% said that their migraine pain went away 2 hours after taking the medication. Of note, 16% reported experiencing pain relief within 15 minutes of taking the medication.

Some mild and transient treatment-emergent adverse events were reported, including nasal congestion, which was reported by 17.8% of patients; nasal discomfort, reported by 6.8% of patients; and vomiting, reported by 2.7% of patients.

"Historically, there have not been enough effective treatments for treating migraine attacks, especially treatments that are not oral medicines, which can be challenging due to nausea, vomiting, and other GI symptoms that can occur during a migraine," said Kevin Lenaburg, the executive director of the Coalition for Headache and Migraine Patients, in a press release.

"We welcome an important new treatment that combines the long-established efficacy of [dihydroergotamine] with a non-oral, innovative delivery system that allows patients to self-administer wherever they are and at any point within a migraine attack," he added.

Source: http://www.healio.com/news/primary-care/20210903/fda-approves-dhebased-migraine-