Emerging drugs for the treatment of diabetic nephropathy

ABSTRACT

Introduction

Diabetic nephropathy remains a significant economic and social burden on both the individual patient and health-care systems as the prevalence of diabetes increases in the general population. The complex pathophysiology of diabetic kidney disease poses a challenge in the development of effective medical treatments for the disease. However, the multiple facets of diabetic nephropathy also offer a variety of potential strategies to manage this condition.

Areas covered

We retrieved PubMed, Cochrane Library, Scopus, Google Scholar, and ClinicalTrials.gov records to identify studies and articles focused on new pharmacologic advances to treat diabetic nephropathy.

Expert opinion

RAAS blockers have remained the mainstay of therapy for DM nephropathy for many years, with only recent advancements with SGLT2 inhibitors and nonsteroidal MRAs. Better understanding of the long-term renal effects of ambient hyperglycemia, ranging from hemodynamic changes to increased production of oxidative and pro-inflammatory substances, has evolved our approach to the treatment of diabetic nephropathy. With continuing research for new therapeutics as well as combination therapy, the medical community may be able to better ease the burden of diabetic kidney disease.

KEYWORDS:

• Diabetic nephropathy
• emerging diabetic nephropathy
• treatment of diabetic nephropathy

Article highlights

• Diabetic nephropathy is the leading cause of end-stage renal disease in many countries

• There are several targets for prevention of progression of kidney disease and attenuation of disease-specific pathophysiology in the form of targets on hemodynamic effects, antihyperglycemic effects, oxidative stress, and proinflammatory cytokines/chemokines.

• Although there are several agents that are under investigation, very few have FDA approval for treatment of diabetic nephropathy, and few have supporting data from large trials.

• The most notable emerging drugs with data from large trials so far are finerenone, semaglutide, liraglutide, DPP4 inhibitors, and the NRF2 translocator bardoxolone.

• There are several promising new agents in development, largely targeting oxidative stress and proinflammatory cytokines/chemokines that have significant findings in murine studies which in the future may provide new avenues of treatment for diabetic nephropathy.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.