Tolvaptan may slow disease progression, kidney failure in autosomal dominant PKD
Key takeaways:
- The eGFR decline rate for patients on tolvaptan was –2.58 mL/min/1.73 m² per year.
- For patients in the control group, the eGFR decline rate was –4.28 mL/min/1.73 m² per year.
Tolvaptan may slow disease progression and delay kidney failure in young adults with autosomal dominant polycystic kidney disease, according to results of a pooled database study.
“Patients considering tolvaptan initiation are counseled that treatment typically requires long-term adherence and to understand the risks and benefits,” Fouad T. Chebib, MD, of the Mayo Clinic nephrology and hypertension division in Jacksonville, Florida, wrote with colleagues. To better understand long-term effects of tolvaptan, researchers analyzed data from a pooled database of multiple clinical studies in [autosomal dominant PKD] ADPKD, leveraging techniques such as long-term data linkage, patient matching and mixed-effects modeling to assess treatment impact on kidney function over time.
Researchers conducted a consolidated clinical study of patients aged 18 to 35 years with autosomal dominant PKD. The goal was to assess the effects of tolvaptan in a large cohort during longer follow-up than individual clinical trials.
The analysis included 204 patients treated with tolvaptan and 204 controls on standard care. Median follow-up for the tolvaptan group was 4.6 years and 1.7 years for controls.
Chebib and colleagues focused on annual eGFR change rate and the time to kidney failure.
The eGFR decline rate for patients on tolvaptan was –2.58 mL/min/1.73 m² per year and –4.28 mL/min/1.73 m² per year for controls, according to results of mixed-effects modeling.
Results showed a 1.69 mL/min/1.73 m2 per year reduction in eGFR decline rate with tolvaptan, translating to a 40% improvement. In addition, when extrapolating the results for a 35-year period, Chebib and colleagues reported tolvaptan treatment could potentially delay the onset of kidney failure by approximately 11 years.
“Our findings consequently offer valuable insights,” the researchers wrote, “which along with discussions of potential treatment risks, can support informed treatment decision-making for young adult patients contemplating the initiation of tolvaptan therapy.”
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