Eprodisate for the treatment of renal disease in AA amyloidosis

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

Research output: Contribution to journalArticle

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 m2 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.)

Original languageEnglish
Pages (from-to)2349-2360
Number of pages12
JournalNew England Journal of Medicine
Volume356
Issue number23
DOIs
Publication statusPublished - Jun 7 2007

ASJC Scopus subject areas

  • Medicine(all)

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    Dember, L. M., Hawkins, P. N., Hazenberg, B. P. C., Gorevic, P. D., Merlini, G., Butrimiene, I., Livneh, A., Lesnyak, O., Puéchal, X., Lachmann, H. J., Obici, L., Balshaw, R., Garceau, D., Hauck, W., & Skinner, M. (2007). Eprodisate for the treatment of renal disease in AA amyloidosis. New England Journal of Medicine, 356(23), 2349-2360. https://doi.org/10.1056/NEJMoa065644