University of Helsinki, Folkha¨lsan Research Center, Folkha¨lsan Institute of Genetics, Biomedicum, Finland.
Expert Opin Investig Drugs. 2011 Aug;20(8):1057-71. doi: 10.1517/13543784.2011.591785. Epub 2011 Jul 12.
In individuals with diabetes, the presence and severity of kidney disease adversely affects their well-being, significantly contributes to burden of morbidity and increases their risk of a premature death. The efficiency of current management strategies for the treatment of diabetic nephropathy, even in optimal combination, is partial, at best. There remains an unmet need for additional renoprotective interventions in patients with diabetes.
This review presents a comprehensive summary of some of the ?new contenders? for the treatment of diabetic nephropathy that have been tested or are being tested in randomised clinical trials in patients with diabetes with a predefined renal endpoint, but are not currently indicated for renoprotective therapy. Many of these drugs have been in clinical use for other indications, or initially developed for other purposes.
Although substantial progress has been made towards understanding the pathogenesis of diabetic nephropathy, at present there are no new drugs that provide the solutions we want for our patients. Even when used in combination with standard medical care, current data indicate that renal complications are at best only modestly reduced, at the expense of additional pill burden and exposure to off-target effects. Given the ever-growing burden of diabetic kidney disease, there is a substantial opportunity for better and more targeted (?smarter?) therapeutic interventions in this context.
在糖尿病患者中，肾脏疾病的存在和严重程度会对其健康状况产生不利影响，显著增加其发病负担，并增加其过早死亡的风险。即使在最佳组合的情况下，目前糖尿病肾病治疗管理策略的效率也是有限的。糖尿病患者仍然需要额外的肾脏保护干预措施。
本篇综述全面总结了一些在患有糖尿病且具有预设肾脏终点的随机临床试验中已进行或正在进行测试的“新竞争者”，它们可用于治疗糖尿病肾病，但目前不用于肾脏保护治疗。这些药物中的许多已经用于其他适应症，或者最初是为其他目的而开发的。
尽管在理解糖尿病肾病发病机制方面已经取得了重大进展，但目前尚无提供我们期望为患者提供的解决方案的新药。即使与标准医疗相结合，目前的数据表明，肾脏并发症的改善也只是适度的，代价是增加了药物负担并可能出现非目标作用。鉴于糖尿病肾病的负担不断增加，在这种情况下，有很大的机会进行更好、更有针对性的（“更智能”）治疗干预。
