Department of Clinical Pharmacy, University of Michigan , Ann Arbor, MI, USA.
Department of Chemistry and Biochemistry, Brigham Young University , Provo, UT, USA.
Expert Opin Investig Drugs. 2020 Aug;29(8):831-844. doi: 10.1080/13543784.2020.1777276. Epub 2020 Jun 16.
INTRODUCTION: The hypoxia-inducible factor prolyl hydroxylase (HIF-PH) pathway is responsible for regulating the biosynthesis of erythropoietin (EPO) and maintaining iron homeostasis. Investigational drugs that target the HIF-PH pathway are promising alternatives for treating anemia in Chronic Kidney Disease (CKD). AREAS COVERED: This review summarizes recent advances focused on the clinical development of HIF-PH inhibitors (HIF-PHIs) as potentially novel therapies in the treatment of anemia in CKD based on publications available on PubMed and restricted Google searches. We provide a comparison between HIF-PHIs regarding their pharmacokinetics, dosing regimens and safety concerns, structure-activity relationships, and alterations in key laboratory parameters observed in animal models and clinical trials. EXPERT OPINION: HIF-PHIs may be advantageous in some aspects compared to the conventional erythropoiesis-stimulating agents (ESAs). While ESAs could increase the risk of cardiovascular events due to rapid rises in ESA blood levels, HIF-PHIs have been reported to maintain EPO concentrations at levels that are closer to the normal physiological ranges. Although HIF-PHIs have been demonstrated to be relatively safe and effective in clinical trials, long-term safety data are needed in order to establish whether these therapeutic agents will lead to a major paradigm change in the treatment of anemia of CKD.
简介:缺氧诱导因子脯氨酰羟化酶(HIF-PH)通路负责调节促红细胞生成素(EPO)的生物合成和维持铁稳态。靶向 HIF-PH 通路的研究性药物是治疗慢性肾脏病(CKD)贫血的有前途的替代方法。
涵盖领域:本综述总结了基于 PubMed 上发表的文献和受限的谷歌搜索,针对 HIF-PH 抑制剂(HIF-PHIs)作为治疗 CKD 贫血的潜在新型疗法的临床开发的最新进展。我们比较了 HIF-PHIs 在药代动力学、剂量方案和安全性问题、结构-活性关系以及在动物模型和临床试验中观察到的关键实验室参数的改变方面的差异。
专家意见:与传统的促红细胞生成刺激剂(ESA)相比,HIF-PHIs 在某些方面可能具有优势。虽然 ESA 由于 ESA 血液水平的快速升高而增加心血管事件的风险,但据报道,HIF-PHIs 可将 EPO 浓度维持在更接近正常生理范围的水平。尽管 HIF-PHIs 在临床试验中已被证明相对安全有效,但仍需要长期安全性数据,以确定这些治疗药物是否会导致 CKD 贫血治疗的重大范式转变。
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